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Town Hall 53095 Main Road
ELIZABETH A.NEVILLE �y y�; ,
TOWN CLERK t 0 1 P.O. Box 1179
t _ $ Southold,New York 11971
REGISTRAR OF VITAL STATISTICS �,I Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER �
MARRIAGE OFFICER = *®1 %.0"%.0" Telephone(516) 765-1800
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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. 3828-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner LIEB, MARK AND KATHY
Mailing Address 1 P. O. BOX 907
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 14990 OREGON ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-4075
Tax Map No. section 73.00 block 1 lot 3.004
Cross Street COX LANE AND BRIDGE LANE
Issue Date: 11/27/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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y OFFICE OF THE TOWN CLERK /CS Mire
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TOWN OV SOUTHOLD ` �&,.% OQ Application No.3
, ELIZABETH A.NEVII.I.F,TOWN CLERK �C q $10.00 - Residential
P.O.BOX 1179 `
SOUTHOLD,NEW YORK 11971CA �����, $25.00 - Non-Residential
, • --- Telephone v _:0,( * 0:10.6
(51 6) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
�.- OCT 2 o^3 IM
for
I own Clerk Sournold
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
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Fee $ / t�
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. DATE `0 -,a7-- W
OWNER NAME: /70.4_1, "I'40447dk' 6
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OWNER MAILING ADDRESS: / 'Jq g.Q 6p
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OWNER PROPERTY ADDRESS: -,50----1-1.—(2.--.
OWNER TELEPHONE NUMBER: 6-1(a— 1 - _ - / 7'-
a TAX MAP NO. : Section 7 ) Block / of 3
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CROSS STREET: 05X- aa...-e..., 01 _..e._-
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential 1.7 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.)
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RECEIVED .BY:
T citn Clerk's ffice
DATE: /0/ -7 7Z_:_______
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