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HomeMy WebLinkAboutFaught, Lynn (2) /e, *pG SO!/ryol ELIZABETH A. NEVILLE $ 4 � Town Hall, 53095 Main Road TOWN CLERK * * P.O. Box 1179 ` Southold New York 11971 REGISTRAR OF VITAL STATISTICS k‘f;fj � ,� >MARRIAGE OFFICER i0 g� Fax (631) 765 6145 RECORDS MANAGEMENT OFFICER . �'C �I�, Fax (631) 765-1800 FREEDOM OF INFORMATION OFFICER DU +11°°�� Southold, OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 4339-R Residential X Non-Residential Fee $ 10.00 New Existing X Name Of Owner LYNN FAUGHT Mailing Address 1 2009 BELMONT RD NW #401 Mailing Address 2 City St Zip WASHINGTON DC 20009-0000 Property Address 1 405 LAKE DRIVE Property Address 2 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 202-483-1117 Tax Map No. section 59.00 block 5 lot 210 Cross Street KENNEYS ROAD Issue Date: 6/14/07 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) ', �o� gOFFO(,t,G ELIZABETH A. NEVILLE d h`Z` y� Town Hall, 53095 Main Road TOWN CLERK P.O. Box 1179 y Z Southold, New York 11971 REGISTRAR OF VITAL STATISTICS ` N. Al i MARRIAGE OFFICER : O *. Fax (631) 765-6145 RECORDS MANAGEMENT OFFICERL ' Dpi/ Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER 0'( �, southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION OPERATION PERMIT CESSPOOL or SEPTIC TANK Residential @ $10 /or Non-Residential @ $25 -- Application No.0 J R3_l Permit No. 3 5 411 R Owner Name L ry Owner Mailing Address DOR �o�� I � h?1„7 Lf-D1 1„7�SI•�'�+ID t)G a_© (709 Owner Property Address LtQ cS o LA-Loict k) l 19 7 / Owner Telephone No. O — 141?. —1(t7 Tax Map No: Section 59 Block Lot a, 1.00 Cross Street 1rC e„n.� ' S o Please check each that applies: New Construction Alteration to Existing System C.v PJ`Ef c D c c c 1 Residential >4_,. Non-Residential NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. (Locate building and system; give north arrow and approximate distance in feet from system to building and closest road. New construction may submit copy of survey with SCHD approval.) `` � CQ��oC O� Signa/T.) pplicant , Date Received by: SECTION 7209 CF THE NEW YORK STATE ' EDUCATION LAW. y/ COPIES OF THIS SURVEY MAP NOT SEARING / � THE LA D SU].VEYOR'S INKED S'AL OR „..„.....7. DC7 EMROS.0 SIAL VIA.11 r.•11 U Ca: SIUC^LD c° l44 TOAYALJDIU BE . �_PY. Cyt�YO - GUARANTEES INDICATED HEREON SHAH RUN ONLY TO THF'E'SON FOR WHOM THE SURVEY �..€• �� 'l IS PREFARLD,A..L J. HS SeHALI IU IHE _ _ _ __ �p TITLE COMPANY,v. '✓ MENTAL AG.(JCY AND T LENDING INSTITUTION L E HERLUh,AHD TO THE ASSIGNEES OF TH. ....i:I;:G INSTI• (� �� ''tea$ TUTION.GUARANTEES ARE NUI InANSFERASLE 55 1 TO ADDITIONAL INSTITUTIONS OR SUSSEQUENE L� ,� 1� r ��r • OWNERS. r th ^�03J' • , 4174:00P.A4/ _ • •,t- ,tao �'....\A 'MA.P CSF LAND I `_ SURVEYED FOR s"tc* ELJG= .E LC' RE TTA BRAsACCH IA v tt.V AT 0 SO1,JTk4O Li Surrot CCU VI T Y N.Y 4 I Jr t oa Z, , o ave rlhe N . Tie line !4486 . ti ceEAr .r-)n �.., r, v • Gµavv+H�red f"a 7pa '7" i f Cie Gsrdva -tne " c.c.), • +r,• I a co,+v'ald S vil✓as eaP k ' s. ,A1e: cU't I ' 44 �I •eo.+ r 19, 1973 . qrs WYv s to1 n1-t L r}�e�.,•� a rPeR ECW \hFt�p. "rt-o-t. f"'ti C. Lice vis c3 1—a+,4 �SSLir-vet c- `11-ftit NE ta8�c:4Gv5. �vF'�npQr+ t,aew '`+c>Yk