HomeMy WebLinkAboutSharman 0,#1111OFF04
JUDITH T.TERRY tI414 t; Town Hall, 53095 Main Road
TOWN CLERK ® P.O. Box 1179
�� Southold,New York 11971
REGISTRAR.OF VITAL STATISTICS O �� Fax(516) 765-1823
MARRIAGE OFFICER `- y ��
RECORDS MANAGEMENT OFFICER ;'�Ol ,'�� Telephone(516) 765-1800
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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. 3653-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner SHARMAN, FRED
Mailing Address 1 P. O. BOX 184
Mailing Address 2
City St Zip ORIENT NY 11957-0000
7
Property Address 1`?� rSTEPHENSON b/94 /a�
Property Address 2
City St Zip ORIENT NY 11957-0000
Owner Telephone No. 516-323-3610
Tax Map No. section 17.00 block 1 lot 9.002
Cross Street MAIN ROAD
Issue Date: 6/26/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
` '� n iii
OFFICE OF THE TOWN CLERK cOFO(A' .
Town of Southold �0,• C� i� Application No3653
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road , ' `•i '� $10.00 - Residential
P. O. Box 1179 v' '' }:`" : $25.00 - Non-Residential
Southold, New York 11971 O Y.• ` }# a • •
Telephone 1,_Ol �'6 "
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
949
Fee $
DATE 1 10.1A
OWNER NAME: C7-40 Irt 9'k- iA)
OWNER MAILING ADDRESS: 116 � �` �12 � .� ` ‘\ si
OWNER PROPERTY ADDRESS : 6\ L"" W
OWNER TELEPHONE NUMBER: 3 E, I
TAX MAP NO. : Section 1.1 Block 1 Lot
CROSS STREET: (PP
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.)
GIA(*),Signature of Applicant
RECEIVED Y•
EI EDB
Town erk's-Office - - - - -
DATE:
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