HomeMy WebLinkAboutSpicer ,/0' S.))SOFFo�,�coG,
JUDITH T.TERRY Town Hall, 53095 Main Road
TOWN CLERK y P.O. Box 1179
^y t Southold,New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER ` y� 1�/, Fax (516)765-1823
RECORDS MANAGEMENT OFFICER• : OIiNg � ��� 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. 3458-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner SPICER, ANNA
Mailing Address 1 100 OLD SHIPYARD LANE
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 100 OLD SHIPYARD LANE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-3052
Tax Map No. section 64.00 block 2 lot 52.000
Cross Street L'HOMMEDIEU
Issue Date: 4/22/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK �FFO3v5-g__
Town of Southold �e �/ =% Application No.
Judith T. Terry, Town Clerk - J►
Town Hall, 53095 Main Road t $10.00 - Residential t____------
p.
____--- ._p. O. Box 1179 U' n ;) $25.00 - Non-Residential
Southold, New York 11971 � e,`,
Telephone ®.( yi�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
• DATE /"7h
OWNER NAME: 04) s'1 6p / c,(cz.r
OWNER MAILING ADDRESS: JO (2/d (fairy( -6 r� e--
H- d 1d N Y-/ /197/
OWNER PROPERTY ADDRESS: , __6_a- ] _ _
OWNER TELEPHONE NUMBER: 7 -- JU J Z
TAX MAP NO. : Section /7 Block Lot 4 Z,
I`'
CROSS STREET: b�
TYPE OF SYSTEM_: Septic Tank • ,L/ 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.)
Signature of Applicant
RECEIVED BY: H.
• - . • ' Town C erk's Office •
DATE:, 6-7/- 0201 -1.6 -
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