Loading...
HomeMy WebLinkAboutArm /'�/� ooli tafFartger � f • �?UDITH T.TERRY tt' s ���: Town Hall, 53095 Main Road TOWN CLERK ; w � kI' € � ; P.O. Box 1179 '' REGISTRAR OF VITAL STATISTICS �t ®a® * '-k; Southold,New York 11971 MARRIAGE OFFICER .4 ®�/ Fax(516) 765-1823 RECORDS MANAGEMENT OFFICER � ZE1 •see. Telephone(516) 765-1800 FREEDOM OF INFORMATION OFFICER ,,."s OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 165-N Residential Non-Residential X Fee $ 25.00 New Existing X Name Of Owner ARM, HERBERT S. Mailing Address 1 1675 JOCKEY CREEK DRIVE Mailing Address 2 City St Zip SOUTHOLD NY 11971-0000 Property Address 1 1675 JOCKEY CREEK DRIVE Property Address 2 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 516-765-2995 Tax Map No. section 70.00 block 2 lot 19.004 Cross Street OAKLAWN AVENUE Issue Date: 12/10/96 Judith T. Terry Southold Town Clerk (TOWN SEAL) 0 // III''I Y f'/, / 63/ 3 OFFICE OF THE TOWN CLERK c�VFFOH, _ (© / Town of Southold . ' COG,\ Application No. Judith T. Terry, Town Clerk �% �� .1 Town Hall, 53095 Main Road I $10.00 — Residential ny, V P. O. Box 1179 cra k. :s;g ,t,, " 1rr �' $25.00 - Non-Residential- Southold, New York 11971 O'�f .s+ . •$ Telephone = 1 (516) 765-1801 - TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ • DATE !'d/ /f//Q/ OWNER NAME: 11 exber--f 5 /MO OWNER MAILING ADDRESS: /675- To' Creel ,vr71G--1 Sou2G OWNER PROPERTY ADDRESS: 1 OWNER TELEPHONE NUMBER: eI(,5----geNs5� TAX MAP NO. : Section —2 e) Block a Lot / q4 171 CROSS STREET: C) . 1./ --1 11—.GI---ev' A v „..._-...... .._ 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.) 14/44a(-04 Signature of Applicant RECEIVED BY: 1 AO _/ Xi - -6-W7-Clerk's O fice DATE: /oZ2/br�f , \Vy\ \ < f ir op r // /,,s'oo o,�e/..1"0 ',o ,',e�y F b ��.3 •4p' n K l'e 4r.00570 '�e%/ Med3\ '/68 3 3• Sc? ,, coh cv �(� 'fj� y` J 83 `err Q/ Ri eV Pe ' 'l ` ry\ e�Ic%Std�s -- i / J \/h -;ss--Fop/ / P-- / 329. D.,' i- r awn /.;,,E je \ \�r` Tse k•r a � rk `./ ' / Ss -_ 0 �4� `OZ �1 1 r „'r b t O ! 3a,a9e n„�� h t 1.Or 0 4T.7v Mr . d - h S 9�°°'5F N 79°57 5�E s7''4 ' r I Q 027 . :184.38 --�,3�0 E.l .3 4 '� ti