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JUDITH T. TERRY ; Town Hall, 53095 Main Road
TOWN CLERK ® r P.O. Box 1179
REGISTRAR OF VITAL STATISTICS tG. �` Southold, New York 11971
Fax (516) 765-1823
MARRIAGE OFFICER �,���
RECORDS MANAGEMENT OFFICER __ 1 �,°I Telephone (516) 765-1801
FREEDOM OF INFORMATION OFFICER
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3273-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner THORP, JANET T.
Mailing Address 1 P. O. BOX 795
Mailing Address 2
City St Zip EAST MARION NY 11939-0000
Property Address 1 230 SOUTH LANE
Property Address 2
City St Zip EAST MARION NY 11939-0000
Owner Telephone No. 516-477-2335
Tax Map No. section 38.00 block 6 lot 15.000
Cross Street SYLVAN LANE
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Issue Date: 10/27/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE; - F THE TOWN_ CLERK
r S�FFO(,r� _ a �-7�
Town of Southold C' .
Judith T. Terry, Town Clerk ���\ Application No.
Town Hall, 53095 Main Road R�: _ < I $10.00 - Residential
P. O. Box 1179 � $25.00 - Non-Residential
Southold, New York 11971 O A0•$
Telephone _OI N�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE Oer /,11
OWNER NAME: V,l%/6 �''
OWNER MAILING ADDRESS:—Re 273.1x
?7i'®
,•'ss / . 7 A N i/79
OWNER PROPERTY ADDRESS: p30n
egsr 77'/O,/ // //73./
OWNER TELEPHONE NUMBER: 177 -
TAX MAP NO. : Section 31r9 Block £ Lot /i
CROSS STREET: gy L4? .647#2
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.)
‘5:4 /411
Signature of Applican /
RECEIVED BY:
Trr,r 's Office
DATE: OCT 2 '' 1994
town Clerk Southold •
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- ; y tt, •pNAUTHORItED ALTERATION OR ADDITION
yy{{ p '. . J6 0 70 THIS SURVEY IS A VIOLATION OF
•. C } 4`, ® / SECTION 7209 OF THE NEW YORK STATE
11 217 - / I EDUCATION LAW.
t.) P. ., S ',{ - / / CONES OF THIS SURVEY MAP NOT BEARING
, / / THE LAND SURVEYOR'S INKED SEAL OR
EMBCS5T3 SEAL SHALL NOf BE CONSIDERED
1 1 / / '70 Be A VALID TRUE COPY. .
L . 'I L. t / GUARANTEES INDICATED HEREON SHALL RUN }7
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,tli PREPARED,AND ON HIS BEHALF TO THE
TITLE COMPANY,GOVERNMENTAL AGENCY ANS
d• .,•• •��, C`, i' 1LENDING INSTITUTION LISTED HEREON, AND
�e.tO�„�a r TO THE ASSIGNEES OF THE LENDING INSTI•
. I -.. ^' bL�4�_��� t'i' TUTION.GUARANTEES ARE NOT TRANSFERAbL
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