HomeMy WebLinkAboutTrue JUDITH T.TERRY „ .°• Town Hall, 53095 Main Road
TOWN CLERK ' • P.O. Box 1179
PrtREGISTRAR OF VITAL STATISTICS Southold,New York 11971
MARRIAGE OFFICER \� •
. I Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER ®*/ j ,,•'� Fax
(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. 3617-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner TRUE, MICHAEL
Mailing Address 1 C/O ELE DEVELOPMENT CORP.
Mailing Address 2 P. O. BOX 1143
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 815 GABRIELLA COURT
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 000-000-0000
Tax Map No. section 108.00 block 4 lot 7.039
Cross Street ELIJAH'S LANE
Issue Date: 4/30/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
Le,4 tS3G /
' FFICE OF THE TOWN CLERK �c
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(13\\FFair
Town of Southold Application No.
Judith T. Terry, Town Clerk �� ,' �►
Town Hall, 53095 Main Road - $10.00 - Residential
P. O. Box 1179 ,gA« fir► �' $25.00 - Non-Residential
Southold, New York 11971 O ''
Telephone =?la/ 4it •
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE LA l n l ��
OWNER NAME: M 1 CI'1 0. 0 \ 1-1(
l,L
OWNER MAILING ADDRESS: S I C� -a_ i a_ I I z.
[tet -I-tA C l< 1 Irl �-
OWNER PROPERTY ADDRESS: me-
OWNER TELEPHONE NUMBER:
•
TAX MAP NO. : Section cg Block 4 Lot —7 :59
CROSS STREET: G I j LA'#e-
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New F'"-- 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.)
7‘,eeZ7
Sig Fire of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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SURVEY OF
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ELIJAAS LANE ES TA TES, SECT. 2
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( • - F/LED OCT. 8, 1996 FILE NO. 9972
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0 TOWN OF SOUTHOL D
- - , o_ �-P SUFFOLK COUNTY, N Y.
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oPt,nr O ,� 1000 - 108 - 04 - P/O 7.1
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`�31 Dec. 4, 1996
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2-1?-' SWFOIX COUNTY DEPARTMENT OF HEALTH SERVICES
PERMIT PM.APPROVAL OR COPNTRJCl O,?i FOR A \,
• SINGLE TAMMY - _ "1• y- % ONLY
DATE FEB 0 _.1 ' 1214,REF.NO. b ' 7 -4°- • ,
APPROVED ' - , 1 -
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EDEPIRES THREE YEARS FROM DATE OF APPROVAL , '! »'-,
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