HomeMy WebLinkAboutGates JUDITH T.TERRY ® ;rry=: Town Hall,53095 Main Road
TOWN CLERK �
�;:v P.O.Box 1179
Pvt. Southold,New York 11971
REGISTRAR OF VITAL STATISTICS � ��, �/ Fax(516)765-1823
MARRIAGE OFFICER �
RECORDS MANAGEMENT OFFICER 'itill1 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. 3375-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner GATES, LLOYD AND HELEN
Mailing Address 1 60 GAGENS LANDING ROAD
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 60 GAGENS LANDING ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-3942
Tax Map No. section 70.00 block 10 lot 16.000
Cross Street SOUTH STREET
Issue Date: 8/15/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK c3VFFU(,(�"-- '
Town of Southold CQG= Application No. 33 75
Judith T. Terry, Town Clerk �� ��
Town Hall, 53095 Main Road .. $10.00 - Residential V
P. O. Box 1179 cry $25.00 - Non-Residential
Southold, New York 11971 �,I ��`�
Telephone _a.! �0'�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ 10,
DATE - /Q /?
OWNER NAME:
OWNER MAILING AD�RESS: 6U ,jar d7e:2-0-7e="4-,
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: 176. -c:— 39
Ail 3 387 70., —/c9 "4–/6
TAX MAP NO. : Section Block Lot
CROSS STREET:
TYPE OF SYSTEM: Septic Tank 7. 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.)
'AdOe
gna ure of A.plicant
RECEIVED BY:
Town Clerk's Office
DATE:
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aMAUTHO1aZED ALTERATION OR , ' " ,• --.---i---- ---- -•- -• ----- •- - LJ f 111��� -- -- _ ,
'+O THIS SURVEY IS A VIOLATION OF j - a -, -- •-- — —'-' "' "--"- - _
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SECTION 7209 OF THE NEW YORK STATE ,. _ ` • `> 1`�g 13:‘
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EDUCATION LAW. - _ K.' %. - i + �J ;$, �� .-'
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THE LARD SURVEYOR'S INKED SEAL OR - • (� -, t- - `;t_, - - - 'i t+, - - - -
EIICCSSCD SEAL SHALL NOT 6E CONSIDERED - ti - - - - • " j"t(h, + _ _ + I y -
tO CE A VALID iTUE COPY. : _ N ,''4 r. nQ' •
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GUARANTEES iND!CATED HEREON SHALL RUN ' •>',t> •_ i .^r
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