HomeMy WebLinkAboutMinhas, Absar (2) ��,�%pF SOU/A/-
ELIZABETH A. NEVILLE �° 0 L Town Hall, 53095 Main Road
TOWN CLERK , 4111 * P.O. Box 1179
REGISTRAR OF VITAL STATISTICS H41cSouthold, New York 11971
MARRIAGE OFFICER L i0� , Fax (631) 765 6145
RECORDS MANAGEMENT OFFICER L Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER -.0ONTIi* I I,' southoldtown.northfork.net
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4290-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner MINHAS, ABSAR
Mailing Address 1 PO BOX 297
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 6125 COUNTY ROAD 48
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 631-298-0227
Tax Map No. section 139.00 block 3 lot 49.000
Cross Street WICKHAM AVENUE\
Issue Date: 8/05/05 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE i 0 I Town Hall, 53095 Main Road
TOWN CLERK : ; P.O. Box 1179
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REGISTRAR.OF VITAL STATISTICS �O ��� Southold, New York 11971
MARRIAGE OFFICER ;yWA 7- Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER = 1 �001 Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
OPERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @$10 ti or Non-Residential @$25 Application No. qacr
Permit No.
Owner Name A l S {\ ' t i.) S t R-T
Owner Mailing Address ?O• E.ox aq7 mO± L FJ J
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Owner Property Address G/ CO Lk A TY I -t , "-E-z
/Yln 7-7-1 ToL N )19S 2
Owner Telephone No. - 4aq
Tax Map No: Section / 3 e1 Block Lot `—C`7• o0
Cross Street w i C V (-1-l4 ANH2.
Please check each that applies: New Construction t•
Alteration to Existing System
Residential Non-Residential
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATIO del
building and system; give north arrow and approximate distance in feet from system . . I I ding
and closest road. New construction may submit copy of survey with SCHD approval.)
Signature of Applicant Date
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Received •
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