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JUDITH T.TERRY ����S yet Town Hall, 53095 Main Road
1.TOWN CLERKci3 ; P.O. Box 1179
, P � Southold,New York 11971
REGISTRAR OF VITAL STATISTICS < O ��� Fax(516) 765-1823
MARRIAGE OFFICER ..4* �a���� Telephone (516) 765-1800
RECORDS MANAGEMENT OFFICER 4,1 ��
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK •
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3454-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner LATHAM, JAMES P.
Mailing Address 1 P. O. BOX 8211
Mailing Address 2
City St Zip ORIENT NY 11957-0000
Property Address 1 2790 PETERS NECK
Property Address 2 •
City St Zip ORIENT NY 11957-0000
Owner Telephone No. 516-323-2642
Tax Map No. section 32.00 block 1 lot -2-0tY0 0ft/
Cross Street NARROW RIVER ROAD
Issue Date: 11/10/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
' F•nCE OF THE TOWN CLERK �FFoLI
Town of Southold 1 ���� Application No�? ,4
Judith T. Terry, Town Clerk :
Town Hall, 53095 Main Road g ;< $10.00 - Residential
P. O. Box 1179 u3
$25.00 - Non-Residential
Southold, New York 11971 O *.$Telephone
640 jit.
(516) 765-1801
TOWN OF SOUTHOLD
. SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /0J•a0
DATE 96
OWNER NAME: . 14
- OWNER MAILING ADDRESS: e t te. ` G6�
OWNER- PROPERTY ADDRESS: 27/0 - /25TaU-s //'/
OWNER TELEPHONE NUMBER: 516
TAX MAP NO. : Section O-2/2 Block I Lot 2
CROSS STREET: - /x��/'7/7'2•1`'"
•
TYPE OF SYSTEM: , Septic Tank ; ;61-- New Existing
Cesspool S hp° 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.)
signature of Applicant
RECEIVED BY: sem%/ '.- "ail/
t, - .w, G - :k's Office --
DATE: ' _ _
RECEIVED -
APR S 1996
Lawn £i+erk Southold-
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