HomeMy WebLinkAboutMoore (6) /c$ FOL,rc
JUDITH T.TERRY kl°' 'f'f'► Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
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REGISTRAR OF VITAL STATISTICS 4 Fax(516) 765-1823
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER =�®,( * NO•01° 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. 3649-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner MOORE, WILLIAM D.
Mailing Address 1 370 TERRY LANE
Mailing Address 2
City St Zip SOUTHOLD NY 01197-0000
Property Address 1 370 TERRY LANE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-0034
Tax Map No. section 65.00 block 1 lot 6.000
Cross Street TOWN HARBOR
Issue Date: 6/20/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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„OFFICE OF THE TOWN CLERK cOFO(,(� -
Town of Southold Application No. 36,W
Judith T. Terry, Town Clerk �`
Town Hall, 53095 Main Road ' -4 I $10.00 - Residential
p. O. Box 1179 cr3fyj' �5. f:` ► `' $25.00 - Non-Residential
Southold, New York 11971 O ' •�`
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Telephone ( �►
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLI CAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE L"
OWNER NAME: \�-�.1`D��^^' O cO Ct �
OWNER MAILING ADDRESS: 3) 0 L
OWNER PROPERTY ADDRESS : 'M�X
OWNER TELEPHONE NUMBER: -164`7' 31f
TAX MAP NO. : Section 4 Block / Lot
CROSS STREET: OritS, 0,Prit.405 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.)
i.nature of Applicant
RECEIVED BY:
TrC 's Office
DATE: 197
JUN 19
Southold Town Clerk
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