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HomeMy WebLinkAboutVandenheuvel 44) JUDITH T. TERRY � 4. C Town Hall, 53095 Main Road TOWN CLERK • 4, � P.O. Box 1179 t,. ' `' � Southold, New York 11971 REGISTRAR OF VITAL STATISTICS d} __$ �rt Fax (516) 765-1823 MARRIAGE OFFICER ��� Telephone (516) 765-1801 RECORDS MANAGEMENT OFFICER - _ � srd o. 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. 3276-R Residential X Non-Residential Fee $ 10.00 New Existing X Name Of Owner VAN DEN HEUVEL, STANLEY Mailing Address 1 300 HOLLOW TREE RIDGE ROAD Mailing Address 2 City St Zip DARIEN CT 06820-0000 Property Address 1 3975 SOUTH HARBOR ROAD Property Address 2 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 203-655-1050 Tax Map No. section 78.00 block 3 lot 12.001 Cross Street ROUTE 25 • Issue Date: 11/04/94 Judith T. Terry Southold Town Clerk (TOWN SEAL) OFFICE OF THE-TOWN CLERKS�FFOur �'- Town of Southold o c 3 `7� Judith T. Terry, Town Clerk �� ,_ • �� Application No. Town Hall, 53095 Main Road $10.00 - Residential P. O. Box 1179 cry ' $25.00 - Non-Residential Southold, New York 11971 O �` Telephone 4'0j * se" (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for - _. OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ /0' e DATE Oak 31' 'f OWNER NAME: Off_ Le V77eh Stanley van den Heuvel OWNER MAILING ADDRESS:' 1300 Hollow Tree Ridge Rd. � b fl (/ (,(, rjf� @ I ` Darien,Conn. 06820 icl(g'e1,1 ( C.4. �4,Q,2, 0 OWNER PROPERTY ADDRESS: :3(``15 3 6644 if14RQoR RD OWNER TELEPHONE NUMBER: (a4 /p,s, TAX MAP NO. : Section 78 Block 3 Lot f‘,7. I CROSS STREET: TYPE OF SYSTEM: Septic Tank ,New Existing Cesspool New Existing X 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.) 0/10(eg0414' idt--UA.C2 Signature of Applicant RECEIVED BY: Town Clerk's Office DATE: ' --„..Q:.„..,..-,-• •.. 1...'loop.,..:2,-,,-.-4-_-i-s. ::5:,:,T,,,,..:.„..-, i,„ :....,-- .. " .••-.-. ,,' „if,•, ••Ai,a --, . , s:.‘,,. • ..... .. sl,,.., ;: " • -,----'- ..... _.- ,rIt'S7"-",. .i.-- .... • *.1 1',.. ' • ".'' 8‘..':'•‘'.'0,Y;i:' ..,...:'..%.'?' I .'‘0%`• ',:'.' •`.>Y,... '0':,e,., -- -7.-- ::_. . . . 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