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Home My WebLink AboutManos A OFFOLit JUDITH T.TERRY c:31 Town Hall, 53095 Main Road TOWN CLERK ` y a P.O. Box 1179 i Southold,New York 11971 REGISTRAR OF VITAL STATISTICS `®� ��1, Fax(516) 765-1823 MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER V:�.` `�.�®,�I Fax (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. 3525-R Residential X Non-Residential Fee $ 10.00 New Existing X Name Of Owner MANOS, JAMES Mailing Address 1 P. O. BOX 1543 Mailing Address 2 City St Zip SOUTHOLD NY 11971-0000 Property Address 1 2147 LAKE DRIVE Property Address 2 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 516-765-1316 Tax Map No. section 59.00 block 5 lot 2.002 Cross Street WEST DRIVE Issue Date: 10/10/96 Judith T. Terry Southold Town Clerk (TOWN SEAL) O FICEtsOF THE TOWN CLERK cOF Town of Southold OHO CQG Application No.�5 2 Judith T. Terry, Town Clerk .z, ��. � $10.00 - Residential `J Town Hall, 53095 Main Road — P. O. Box 1179 U' =' • $25.00 - Non-Residential Southold, New York 11971 O . • Ne Telephone �.( /% (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ DATE lO Y OWNER NAME: i0/7/4ed OWNER MAILIN ADDRESS: PD•,ADX /..CV 3 s'eaT64o,-O vy // ' 7 / _OWNER- PROPERTY ADDRESS:_ 21 >47 /4&-e 1), _ So dr4`ac,P "1/ % Ji 9 7/ OWNER TELEPHONE NUMBER: /3 / TAX MAP NO. : Section j Block 0 Lot 2' CROSS STREET: - Gc/1f 7— ,9,e,' —c • TYPE OF SYSTEM: Septic Tank _ (/,± New Existing �T 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.) 9-i . io Ap )licant • RECEIVED BY: Town Clerk's Office- - . 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