HomeMy WebLinkAboutMoore (2) #11 of Mir
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JUDITH T.TERRY ` w Town Hall, 53095 Main Road
TOWN CLERK k P.O.Box 1179
?Dv Southold,New York 11971
REGISTRAR OF VITAL STATISTICS V
MARRIAGE OFFICER ® �1 Fax(516)765-1823
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RECORDS MANAGEMENT OFFICER : (94(94 „d��
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. 3407-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner MOORE, FRANK AND JANET
Mailing Address 1 P. O. BOX 1146
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 640 CASES LANE
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-7991
Tax Map No. section 109.00 block 5 lot 8.000
Cross Street FAIRWAY LANE
Issue Date: 11/24/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
as „
OrFICE OF THE TOWN CLERK 1S�fF00( �1
T;- . - Town of SoutholdCQ� Appli"cation No.
, �
Judith T. Terry, Town Clerk =�
Town Hall, 53095 Main Road ... $10.00 - Residential
P. O. Box 1179 2ci $25.00 - Non-Residential_
Southold, New York 11971 O I`
Telephone ( To-,
ir
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit.No.
Fee $ /7d
DATE /c/ "*----
OWNER NAME: ���
OWNER MAILING ADDRESS: f Pj7 / '� -S /1rc
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: 73 ��- 2
TAX MAP NO. : Section /0 ? Block 3 Lot
gr
CROSS STREET: 7`
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool 17-,, New Existing
Residential Y Non-Residential
LOCATION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow and feet
4of distance, approximately, to building and closest road.)
‘10-5e.s.
iv- Rfv'l/szos Signatu e of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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