HomeMy WebLinkAboutGriffin St
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JUDITH T.TERRY �� y�c Town Hall, 53095 Main Road
TOWN CLERK y _ P.O. Box 1179
1 Southold,New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER 441 �� ���/ Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER ,( * �°al��i 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. 3468-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner GRIFFIN, THEODORE E.
Mailing Address 1 P. O. BOX 554
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 WOODCLIFF DRIVE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-8449 P,U.
Tax Map No. section 107.00 block ---6 lot 17.000 ///
519
Cross Street GRAND AVENUE /
Issue Date: 5/16/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK ����F�(� - 7 (oe
Town of Southold �� Qli Application No.
Judith T. Terry, Town Clerk ,,=
Town Hall, 53095 Main Road ) $10.00 - Residential
P. O. Box 1179 ;'. ; ;' $25.00 - Non-Residential
Southold, New York 11971 Obi
Telephone : i, ��*�••
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
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APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE 5/8 J61
OWNER NAME: � co e - 6— tom' e F 1 .
OWNER MAILING ADDRESS: P.O. BOY 65 (4 wcodGi;1°F pa
VInipr•i.4 vcA /V(_ 11.5
OWNER PROPERTY ADDRESS: Wont) GA': ,PP ;'pe , Yin A.14 4
OWNER TELEPHONE NUMBER: L-'e g if q9
TAX MAP NO. : Section / 07 Block Lot /7.
CROSS STREET: t4)do,d De 4- g-„ Avg
TYPE OF SYSTEM: Septic Tank I/' New Existing
Cesspool New Existing
Residential V 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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Signature of Applica,*
RECEIVED
' Town Jerk's Office
DATE: w - lG
61
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SECTION 7204 CF TIE NEW YORK STAT!
��, EDUCATION LAW.
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I STAMP
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TEST HGL� SUFF. CO. DEPt.OF HEALTH S iIWIORS • STATEM• ENT OF INTENT
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PoR APPROVAL OF CONSTRUCTION, ONLY
Stacy/rr THE WA1'EN SUPPLY AND SEWAGE i
r,- DATE: �, 'bISPOSAL SYSTEMS POR THIS REST.
St7leki lopH1,
r} ,o,,,.( b ENCS WILL CONFORM TO THE
- - 7' N.S. REF. NO.1
STANDARDS or SUFFOLK CO. DEPT.
4,cyrTd, u
ltedvlI
or HEALTH. SERVICES.
pit vet . APPROVED: .
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17' APPLIeANT •
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