HomeMy WebLinkAboutUtz o,,
ELIZABETH A.NEVILLE �� Town Hall, 53095 Main Road
TOWN CLERK % 2 P.O. Box 1179
APP
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS :, ofi ®1, Fax(516) 765-1823
MARRIAGE OFFICER . 4®
RECORDS MANAGEMENT OFFICER �,I Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER ""' '''s
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3802-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner UTZ, SUSAN P.
Mailing Address 1 P. O. BOX 166
Mailing Address 2
City St Zip ORIENT NY 11957-0000
Property Address 1 295 YOUNG'S ROAD
Property Address 2
City St Zip ORIENT NY 11957-0000
Owner Telephone No. 516-323-2799
Tax Map No. section 18.00 block 1 lot 12.000
Cross Street ROUTE 25
Issue Date: 7/23/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK cOFULA' =
Town of Southold &,% • e4 _\ Application No..3S—e '-
Judith T. Terry, Town Clerk 1" y
Town Hall, 53095 Main Road rC $10.00 - Residential
P. O. Box 1179 cr3 nr-rt ;'
$25.00 - Non-Residential
Southold, New York 11971 115;w : *-$
0/ $•19-.0°
1 0'
Telephone .(
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE
OWNER NAME: (/��6JaAr, P i (k-f-
OWNER MAILING ADDRESS: P, 'Q , 130x .t (i
G JW' 17\1Y 114=I51
OWNER PROPERTY ADDRESS: g 45 y au,,h 15 �a4�
D rv'g f i4
OWNER TELEPHONE NUMBER: (t L) fb —•
TAX MAP NO. : Section 1 Block I Lot
CROSS STREET: 7C1 Q (i %C.
TYPE OF SYSTEM: Septic'Tank ' eiv- New Existing
Cesspool )e_ !' 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.)
Signature of Applicant
RECEIVED BY:
'own Clerk Office
DATE: -2 /6„, l /�
!k•
1(:/3