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HomeMy WebLinkAboutLeCren J OFOLir JUDITH T.TERRY �� _ Town Hall, 53095 Main Road TOWN CLERK ; Z P.O. Box 1179 v. Southold,New York 11971 REGISTRAR OF VITAL STATISTICS ®� Fax(516) 765-1823 MARRIAGE OFFICER - 1 RECORDS MANAGEMENT OFFICER ®.( j®,,. Telephone (516) 765-1800 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. 3428-R Residential X Non-Residential Fee $ 10.00 New Existing X Name Of Owner LE CREN, RENE AND AIMEE Mailing Address 1 P. O. BOX 158 Mailing Address 2 City St Zip CUTCHOCUE NY 11935-0000 Property Address 1 8525 SKUNK LANE Property Address 2 City St Zip CUTCHOCUE NY 11935-0000 Owner Telephone No. 516-734-5620 Tax Map No. section 104.00 block 3 lot 13.000 Cross Street MAIN ROAD Issue Date: 1/29/96 Judith T. Terry Southold Town Clerk (TOWN SEAL) ti , OFFICE OT- THE TOWN CLERK CO Mir 4 Town of Southold ,' CQG:\ Application No.=3� Judith T. Terry, Town Clerk .` y Town Hall, 53095 Main Road a . $10.00 - Residential P. O. Box 1179 to • ;� $25.00 - Non-Residential Southold, New York 11971 O'�l 0"/ . .$Telephone �.( (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICAT ION _ . ----- -- - - - - __ - - - , for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ • . DATE VI f oi 6 OWNER NAME: P12,NE, y- il i M eL ).,,,e, C R E M OWNER MAILING ADDRESS: Y 1.1 PEJ)C L rj& ll 1.( i C_v i LAI:. ��/ OWNER PROPERTY-ADDR-ESS: g 5...2, r - ... K I K, 14 P • i aLi ) Q. Lila\4(3 ki a 1 t 9.?) 5 OWNER TELEPHONE NUMBER: ?j _ : C-Z3® TAX MAP NO. : Sectio Block 3 Lot is CROSS STREET:' ® KILN 1< is—MAE' <S2)hl-- gLhildr= >4 TYPE OF_SYSTEM: 7 Septic Tank ' ` ' ' . _ New Existing i Cesspool New Existing V 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.) L Signature of Applicant RECEIVED BY: ., Leitat----- ' ' ' own Clerk's Office • ` • DATE: ', - --.72't�-( . _. . . _-_ - L" . : :4:': 7:7. ;:•J' : M V 1 • . ir.., ri - -________ - ` i A©LAS1' - ` - // - . CP ?dq` .2-C �aa L Y — 4 ,., - „