Loading...
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 '��... .01 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) t ,IIS + 1�0 Q ELIZABETH A.NEVILLE i 0 I Town Hall, 53095 Main Road TOWN CLERK : ; P.O. Box 1179 rft 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 \i1 // 9.-.1 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 id. I gi+9-„si„„LEA_- Received • eo I) 1 r(z iT. 1fl 1-/