HomeMy WebLinkAboutEzzard, Robert ,,///Iii,,
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s ELIZABETH A.NEVILLE ���= OG1 • Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
y Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
ARRIAGE OFFICER v �111 Fax (631) 765-6145
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RECORDS MANAGEMENT OFFICER � Ql �a���� Fax
(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. 4186-R Residential x Non-Residential
Fee $ 10.00 New Existing x
Name of Owner EZZARD, ROBERT
Mailing Address 1 1900 WESTVIEW DR
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 1900 WESTVIEW DR
Property Address 2
City St Zip MATTITUCK NY 11952-0000
owner Telephone No. 631-298-5203
Tax Map No. section 107.00 block 700 lot 21.000
Cross Street BROWER ROAD
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Issue Date: 1/29/03 Eizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
OFF1cCE OI 'TtiE TOWN CLERK S�FFL7L4.J".t. 7�
TOWN OF SOUTHOLD &? 4--. Application No.
ELIZABETH A.NEVILLE,TOWN CLERK $10.00 - Residential
P.O.BOX 1179
SOUTHOL,D,NEWYORK11971 �;�� $25.00 - Non-Residential
Telephone 0( , `��c t.•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit/lNo.
Fee $ /(.)
/DATE C J
OWNER NAME:
'Wier/
£- ZckrJ
OWNER MAILING ADDRESS: /�cv &)"s vt et) (1
IA?a 1 ,t ft-ef"c ag //M--
OWNER
/7 2---OWNER PROPERTY ADDRESS: Gu , ✓ 7 ` 40 br,
-I -1 7 it(c . A/ // '.5z.-__,..,._.
OWNER TELEPHONE NUMBER: C31 c29 03
TAX MAP NO. : Section 7C)7CO Block 7 Lot 4;1:Ci eU
CROSS STREET: 3(-64--
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential •
re 71-7Cj 4T H/,?-12S3 5
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.)
Signature of Applicant
RECEIVED BY: K.
Town CI rk's Office
DATE: / — i>2.-r1 -0 3