HomeMy WebLinkAboutMunier J. 5r
JUDITH T. TERRY .. nx t Town Hall, 53095 Main Road
TOWN CLERK � ,�' P.O. Box 1179
conSouthold, New York 11971
REGISTRAR OF VITAL STATISTICS yk a°4 �'
® i Fax (516) 765-1823
MARRIAGE OFFICER . , ;�`xti 0 Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER
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. 3241-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner MUNIER, LEON L.
Mailing Address 1 P. O. BOX 577
Mailing Address 2
City St Zip LAUREL NY 11948-0000
Property Address 1 4030 PECONIC BAY BLVD.
Property Address 2
City St Zip LAUREL NY 11948-0000
Owner Telephone No. 516-298-8696
Tax Map No. section 128.00 block 6 lot 1 .000
Cross Street DELMAR DRIVE
Issue Date: 8/19/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
u ,
OFTICEOF THE TOWN CLERK E
�FFd
Town of Southold , �S Application No."°2�/
Judith T. Terry, Town Clerk . Ay`
x Y ~ 1
Town Hall, 53095 Main Road 8 Y �7 . _
) $10.00 - Residential
P. O. Box 1179 $25.00 - Non-Residential
Southold, New York 11971 ff : M�O�•�`
Telephone = 1 �
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
•
Fee $ • c ,�/
DATE [J S r"l
OWNER NAME: A (v A . 0A-2/FA
OWNER MAILING ADDRESS: 'P c9 Dec S-7
OWNER PROPERTY ADDRESS: 1/6:1,315 y
fAdUl `, Ai, re ill :
OWNER TELEPHONE NUMBER: 57C ego' w-'�q06"
TAX MAP NO. : Section IA e. 0 Block t p 009 Lot et, t COO
CROSS STREET: p ` 14 1.J
TYPE 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.)
All
/ /
Signature of Applicant
RECEIVED BY
REown Clerk's Office
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DATE: -
- AUG 1 8 1994
lawn Clerk Southold
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