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HomeMy WebLinkAboutLey Ifs,, - JUDITH T.TERRY 1© 1 '; Town Hall,53095 Main Road TOWN CLERK "CA P.O.Box 1179 „ ' `` $ Southold,New York 11971 REGISTRAR OF VITAL STATISTICS 1 Fax(516)765-1823 MARRIAGE OFFICER � �r�, � RECORDS MANAGEMENT OFFICER `Ls' V„l11 , 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. 3342-R Residential X Non-Residential Fee $ 10.00 New Existing X Name Of Owner LEY, CHARLES Mailing Address 1 P. O. BOX 1656 Mailing Address 2 City St Zip MATTITUCK NY 11952-0000 Property Address 1 640 MAYFLOWER ROAD Property Address 2 City St Zip MATTITUCK NY 11952-0000 Owner Telephone No. 516-298-8671 Tax Map No. section 107.00 block 8 lot 26.000 Cross Street BROWER RD.' & WESTVIEW DR. Issue Date: 5/24/95 Judith T. Terry Southold Town Clerk (TOWN SEAL) 1 1 OFFS OF THE TOWN CLERK C��fFQ(A•�'` Town of Southold ,vCQG'_ Application No. 33 P) Judith T. Terry, Town Clerk - Town Hall, 53095 Main Road g < $10.00 - Residential) P. O. Box 1179 � - hi ;' $25.00 - Non-Residential Southold, New York 11971 OO ' ��'`, Telephone `;�0,( • (516) 765-1801 - TOWN OF SOUTHOLD • SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ DATE 41/119L-C • OWNER NAME: LaAA OWNER MAILING ADDRESS: (CAt t Ma GI kLot,a.. l�-Q-, OWNER PROPERTY ADDRESS: _ � CL OWNER TELEPHONE NUMBER: g k - ,,Ga TAX MAP NO. : Section i'07 Block Lot S. ). 6 CROSS STREET: r 4 kijsz "- Lk)Ays1,1,406. h r. TYPE OF SYSTEM: Septic Tank, , '.'>`1 New Existing �V �I Cesspool X 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 ' pplicant RECEIVED BY: n ' t rk's Office .. . DATE: _.MAY 2 4 1995 Ion Cletk Soutt10101 tOV 148 S ,c:=D \Nc 1r