HomeMy WebLinkAboutLemerise 01° OFOLit
\s6 410
1.
JUDITH T.TERRY �e_0, y1` Town Hall, 53095 Main Road
TOWN CLERK ; y P.O. Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS ; ® 0 Fax(516) 765-1823
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER y�o.( '1►a.,,' 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. 3457-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner LEMERISE, JOSEPH E. III
Mailing Address 1 108 RIDGE CRESCENT
Mailing Address 2
City St Zip MANHASSET NY 11030-0000
Property Address 1 875 WELLS ROAD
Property Address 2
City St Zip LAUREL NY 11948-0000
Owner Telephone No. 516-627-3196 1/15i
5r7
Tax Map No. section 126.00 block lot 22.000
Cross Street ALBO
Issue Date: 4/18/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
, iii
OFFICE OF THE TOWN CLERK c,VFFOCA-
Town of Southold �� C-
QG' Application No2VS1
Judith T. Terry, Town Clerk • y
Town Hall, 53095 Main Road E0.00Restia1
P. O. Box 1179 p3 - ; $2500 - Non-Residential
Southold, New York 11971 O
Telephone
�.� l�
•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /o, O
DATE 7 ... K
J
OWNER NAME: J OS�) 6, Le X2,15
OWNER MAILING ADDRESS: / Oj EA/T-
M
M ,s /V. y „ 0 3 0
OWNER PROPERTY ADDRESS: 9 7 J Ez_c_ kb .
2.e2 •
OWNER TELEPHONE NUMBER: /' — 6 .17 — 3/7‘
TAX MAP NO. : Section 6 Block { Lot 02
CROSS STREET: • 9 L 8 U
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..)
Kij
ignatu e of Applicant
RECEIVED BY: � '
Townrk's 0 fi,ce
DATE: 4/-Je-,16 (c7,77 _,_.:Zj
O -- 37.3 —
i . <I
I
D1 STC L000 -
$ECT. 126.00
o BLOCK. 08,00
o LOT 022.000
I
EXIST/NG / STORY
FRAME HOUSE °:
nt
1 / ,
- y;. I7.0' •
•z/
/ ------- 4 7s 0
gy
ESS'D
C.
—20.3'
L
i
r