HomeMy WebLinkAboutTalbot 'Ar 101' S StrFO(
►►oe#,VAOA,
►►�
JUDITH T.TERRY _ y1 Town Hall, 53095 Main Road
TOWN CLERK ; y 2 P.O. Box 1179
1.3•0 Ivy � Southold,New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER ysj'® 0����' Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER i * NO. 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. 311.77-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner TALBOT, THOMAS K.
Mailing Address 1 _ 150 HOBART ROAD
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 150 HOBART ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-5124
Tax Map No. section 62.00 block 3 lot 4.000
Cross Street MAIN ROAD
Issue Date: 6/14/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
rev
`QFFICE OF THE TOWN CLERK �FFO
Town of Southold , 0��� •
`n CQG,� Application No.-3V? )
Judith T. Terry, Town Clerk . ,< y 1.
Town Hall, 53095 Main Road I $10.00 - Residential
P. O. Box 1179 v' - ' $25.00 - Non-Residential
Southold, New York 11971 4, e�`
Telephone 1 '4( %No- ••
•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ td
DATE
OWNER NAME: ,1fOv1ai94
OWNER MAILING ADDRESS: 5-0 ' /7D.1; /gel. A3?4 '
40 0746 l0( Nf /197/
OWNER-PROPERTY ADDRESS: rs/19/19�
OWNER TELEPHONE NUMBER: ,7 P J 7
TAX MAP NO. : Section (7--L' Block 3 Lot 5/
CROSS STREET: / 9i91W 106)9di
7/303,
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool 3 P651,/ New Existing t✓
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:
' Town Clerk's Office
DATE:
, - Q, t" • 6, -ICS * - - t- N---1p , - tofh� rv�yf
v3 - ' s1 % { JD ,rlos or me Ive
1. _ , - a , ' - Iv A �_ C� 0`, - Educe taw.
nlia
�• { •---1 ___-_---1- fl5' survey
�-- Coples o1 flog
i� j v •. 'f3= i'� ® d surveyors hilse
fl. . 3.B SAvalidshall no
- _ ,r "� arae coAY•
i^SCfsf �.� NI
..-It •�- G�rantaes6�d,Aatedhe
I-•••: . - — ,4_ - I �'' ' oNy ParedPersorl for wt
1} =� 4 _V - - on his t
�' _ ��-- - _ - , 1. , ria + may.gc�ernme;
s _ y ^d7B instiiuti;n sled t
i -- + . -• the assignees o:the le
t - - £ ( -L� , S T1-
•
lotion.Guarar tees are nc
T i ♦ `"7 = m additional institutions o
- iI ti, I *t rP -''- - owners.
_ a til\ ;.---�
fi
:5.764'05-,2.0 p�nJ. ' - : .15`0, ..
i. '' l S1
t' '._ : - SUS . .TAY KAP ,pATA, 5 X62.-'3-4 - .r. _ - . , `