HomeMy WebLinkAboutBarnes, John ,,,iii..
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ELIZABETH A.NEVILLE ,/= yi\ Town Hall, 53095 Main Road
TOWN CLERK d P.O. Box 1179
tH Z Southold, New York 11971
REGISTRAR,OF VITAL STATISTICS v'
MARRIAGE OFFICER G �, Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER `�y_'flpl �a0.0 TTelephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ���� southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4173-R Residential x Non-Residential
Fee $ 10.00 New x Existing
Name of Owner BARNES, JOHN AND SUSAN
Mailing Address 1 54300 ROUTE 48
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 54300 ROUTE 48
Property Address 2
City St zip SOUTHOLD NY 11971-0000
Owner Telephone No. 631-765-1570
Tax Map No. section 52.00 block 3 lot 1.000
Cross Street RUCH LANE
Issue Date: 1/13/03 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
111
OFFICE OF THE TOWN CLERK C��FFOC,lC
TOWN OF SOUTHOLD ` 0�� OG Application No. 4 B3
ELIZABETH A.NEVII .F,TOWN CLERK .< $10.00 - Residential
P.O.BOX 1179
SOUTHOLD,NEW YORK 11971 Cr) . $25.00 - Non-Residential
Telephone ei * Ng
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE /00/02-
OWNER
0v/ 0ZOWNER NAME: c/101,, f la..t&'v .I
OWNER MAILING ADDRESS: c31 lea,..le l"'
Soa f /` 47)' //f 7/
OWNER PROPERTY ADDRESS: SQ"2.-C
OWNER TELEPHONE NUMBER: (f3) ?ice-/.5-70
TAX MAP NO. : Section �oC ,� Block 3 Lot 7 �O
CROSS STREET: ekih,,.,_
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New ,2( Existing
Residential X Non-Residential
LOCATION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
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—47- --
Si. - - ure of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
SUFFOLK GOTNTY, NEIAI YORK
Ng
SURVEYED 03-31-aq
AMENDED 05-06-ci i
• SUFFOLK COUNTY TAX #'S
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