HomeMy WebLinkAboutLangner ,, _
JUDITH T.TERRY �1�0x �544: Town Hall, 53095 Main Road
TOWN CLERK ; F P.O. Box 1179
P ' LP7',� Southold,New York 11971
REGISTRAR OF VITAL STATISTICS � � Fax(516) 765-1823
MARRIAGE OFFICER ` ' ®���
RECORDS MANAGEMENT OFFICER _ ®� ������ Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER ,,s"
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3736-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner LANGNER, ANNA
Mailing Address 1 P. O. BOX 703
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 4000 ALVAHS LANE
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-5447
Tax Map No. section 102.00 block 4 lot 1 .000
Cross Street
Issue Date: 12/02/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE QF TINE TOWN CLERK ���FFU .. - ?7,--*Town of Southold ��� c., Application No.,
Judith T. Terry, Town Clerk .�i,,..7. - y�l
Town Hall, 53095 Main Road ' , g -< I $10.00 - Residential
P. O. Box 1179 c • �:' $25.00 - Non-Residential
Southold, New York 11971 O`O �0� ,�`
Telephone _ .( * '.
(516) 765-1801
TOWN OF SOUTHOLD
•
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
- - - for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE 1 01- 1'9
OWNER NAME: An & L ; r r1.5
OWNER MAILING ADDRESS: .Q. . 103
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LaOWNER PROPERTY ADDRESS: y0(, r !!Gi 11s - ya -
ffoRre g
OWNER TELEPHONE NUMBER: 1 -S,'G VT
. 4"73 U , /0c2 '. — �/
TAX MAP NO. : Section Block Lot
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing -
Cesspool New Existing
Residential +� 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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Signature of pplicaat
RECEIVED BY:
Town Clerk's Office
DATE:
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, . , UNAUTHORIZED ALTERATION OP ADDITION •
" TO THIS SURVEY IS A VIOLATION OF
, SECTION 7209 OF THE NEV{YORK STATE
- - V EDUCATION LAWS
COPIES OF THIS SURVEY MAP NOT BEARING
1' THE LAND SURVEYOR'S INKED SEAL OR
I • EMBOSSED SEAL SHALL NOT BE CONSIDERED
TO BE A VALID TRUE COPY.
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GUARANTEES INDICATED HEREON SHALL RUN
ONLY TO THE PERSON FOR WHOM THE WAIF(
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IS PREPARED,AND ON HIS E IIALF TO IH,
TITLE COMPANY, GOVERNMENTAL AGENCY AND
LENDING INSTITUTION L':TFD HEREON, AND
TO THC ASS'G:':S ."F r„c LENDLNCi I1'4f1•/ V
1P �tTULO.N. ....A,,-..1..5 A - ,,r)T TPANSFERABLI
- -h ' TO ADDITIONAL INSIIr..,...V,o ..,,auBSEQUENT
OWNERS.
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