HomeMy WebLinkAboutLevin ,
: fix'
xi
JUDITH T.TERRY 1 ® ��;, { Town Hall,53095 Main Road
TOWN CLERKP.O.Box 1179
yt , $ Southold,New York 11971
REGISTRAR OF VITAL STATISTICS Vi7
. rfit �1,
Fax(516)765 1823
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER � 1�/d6 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. 3412-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner LEV I N, TOM
Mailing Address 1 159 WEST 88TH STREET
Mailing Address 2
City St Zip NEW YORK NY 10024-0000
Property Address 1 CENTRAL DRIVE
Property Address 2 CAPTAIN KIDD ESTATES (LOT 2)
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 212-874-0417
Tax Map No. section 106.00 block 1 lot 25.000
Cross Street LINDA ROAD
Issue Date: 11/24/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
�-
n ,„��
OFFICE OF THE TOWN CLERK �FFU /
Town of Southold o� C®G= � Application No. �G
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road a 1 $10-.00 - Residential
P. O. Box 1179 cry ;' $25.00 - Non-Residential
Southold, New York 11971 4 1�`�
Telephone ( *
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
” for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $• (0
DATE Jo
OWNER NAME: J 1j I
OWNER MAILING ADDRESS: 1c9 M-St �g' S-1-;
04,0 jvvkt
OWNER PROPERTY ADDRESS: CIA-. ►\•►\ /t .
cep-( u
OWNER TELEPHONE NUMBER: C?-0-d
TAX MAP NO. : Section Block Lot
' CROSS STREET: I�G� i d
TYPE OF, SYSTEM: Septic Tank ) ' New Existing
Cesspool I/ 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:
Town Clerk's Office •
DATE:
-. - t } rn�
k
. .
. , .
•
li ri D ..---.
i'' rZjLUT Vst/ 7M1P1 %
\\ --
T i l t. W A:� C � 1Z 1�7 5 C�'�`/�.I j;,�
\ ) .
s, \, „ 14°
eia y1 \ 1.`71(
! 1
I
r \' \'\
Loot r1 oy a-
‘w� - ifras[,i+161 410:i i
F Fti
`-- I 1.1.-14/-7r:
( Lr. G 1�•� K .
ajaor,f
ti.:{.l! ( 'w.
• 1t1 o u)tt O lrif
--
\a' s.\ _ �„(pip� Detk5Fi1-\?
!,c-oFE
11L- 77201
No-rer '
oTt o \'J • `/L,.i -.-U v rl Sor,1
1'
.