HomeMy WebLinkAboutRadmin ��' $ F0`/t�0
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JUDITH T.TERRY ��� Town Hall, 53095 Main Road
TOWN CLERK ; y Z P.O. Box 1179
REGISTRAR OF VITAL STATISTICS G
i Southold,New York 11971
MARRIAGE OFFICER
?i • Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER �__� ®1 `1►�O�• Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER �,
1
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3509-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner RADMIN, NANCYE
Mailing Address 1 1415 NORTH PARISH DRIVE
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 1415 NORTH PARISH DRIVE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-2280
Tax Map No. section 71 .00 block 1 lot 14.000
Cross Street
Issue Date: 8/29/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
„I
'OFFICE OF THE TOWN CLERK OF� �'=
Town of Southold , &4% e, Application Application Nb-
Judith T. Terry, Town Clerk . • : ,.;, y
Town Hall, 53095 Main Road $10.00 - Residential
P. O. Box 1179 c.r3 -'f` ;' $25.00 - Non-Residential
Southold, New York 11971
Telephone *
(516) 765-1801 f•
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ P • n u
DATE g” q
OWNER NAME: t-A \N. �`� OL CI. 1" `\�
OWNER MAILING ADDRESS: 1# / ir `/ O Y 7-4 VIOVS-4
OWNER PROPERTY ADDRESS: /4/1.r .2Ay ' 4 �k4
OWNER TELEPHONE NUMBER: J 1(o '7Z\r—
Cf-'(:)
TAX MAP NO. : Section 0 .24d00 Block 0 / O 0 Lot /c/
CROSS STREET:
TYPE- OF SYSTEM: Septic Tank - _New Existing
Cesspool V 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.)
9-7/1%/4/
•
Si:natu e of Applicant
< RECEIVED BY: -
Town Clerk's Office
DATE:
,
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