HomeMy WebLinkAboutElbow East ••• 1 $FO fr
JUDITH T.TERRY I tc: Town Hall, 53095 Main Road
TOWN CLERK ; y Z P.O. Box 1179
Wi Southold,New York 11971
REGISTRAR OF VITAL STATISTICS `Dy 4,�1� Fax(516) 765-1823
MARRIAGE OFFICER �;�0 `COs Telephone(516) 765-1800
RECORDS MANAGEMENT OFFICER 1
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. 162-N Residential Non-Residential X
Fee $ 25.00 New Existing X
Name Of Owner CLIFF SAUNDER'S - ELBOW EAST
Mailing Address 1 BOX 965
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 50 NORTH SEA DRIVE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-1203
Tax Map No. section 54.00 block 5 lot 22.000
Cross Street KENNYS ROAD
Issue Date: 10/01/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
A • i��
OFFICE OF THE TOWN CLERK 'cFULA-
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Town of Southold �� CQG Application No,A/R /Z 2
Judith T. Terry, Town Clerk
,, .0 10.00Residential
Town Hall, 53095 Main Road 8 ,A� `, � ; � $ - �- ---- -
P. O. Box 1179 tri rat $25.00 - Non-Residential
Southold, New York 11971 O O " W O��`,
Telephone
(516) 765-1801
•
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE
pc c
OWNER I I-t 5oV✓1L'etiL- Mu() CCASf
• OWNER MAILING ADDRESS: ,fox -1 9
Sony-�i o o� Iv ,J // 9 ? (
OWNER PROPERTY ADDRESS ; 5D . /Vora yr_,M 1r
OWNER TELEPHONE NUMBER: 7( S / 2- O3
TAX MAP NO. : Section Lj7-, Block 6 5 Lot a
CROSS STREET: l\'r' ,.� v-‘i,vs /Q G 2II
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
re riplicant
RECEIVED BY: LeV.,AP "I
Tow . Clerk's Office
DATE: /0/9‘
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