HomeMy WebLinkAboutSherman 6111 Oaf gLA e
JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK : ® P.O. Box 1179
6rl Southold, New York 11971
REGISTRAR OF VITAL STATISTICS �' Fax (516) 765-1823
MARRIAGE OFFICER " &-_•$
RECORDS MANAGEMENT OFFICER _ 1 11;144poi!' Telephone (516) 765-1801
FREEDOM OF INFORMATION OFFICER =� ��i!!`
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3305-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner SHERMAN, DORIS
Mailing Address 1 P. O. BOX 1002
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 1180 PINE NECK ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-311.11
Tax Map No. section 70.00 block 8 lot 21 .000
Cross Street BENNETT LANE
Issue Date: 2/08/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
Of i..
OFFICE OF THE TOWN CLERK ��c��FF �""
Town of Southold CQ ' Application No. S 3 OS—
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road g $10.00 - Residential
P. O. Box 1179 crs ;' $25.00 - Non-Residential
Southold, New York 11971
Telephone *-1 AI
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE o2- —
OWNER NAME: c,-1-Dims
OWNER MAILING ADDRESS: 4 O too 's-
c LO
OWNER PROPERTY ADDRESS: lig() q;); 1 . 20
OWNER TELEPHONE NUMBER: S7b -76,..S--3 +I
TAX MAP NO. : Section 70 Block O e Lot Q/
CROSS STREET: BeitIVE7
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool V New Existing r/
Residential p/ 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.)
"S" e""--
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE: -7 ( ��
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