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HomeMy WebLinkAboutVandyne 0 1 t 1 IS JUDITH T.TERRY 111 ; 14 Town Hall, 53095 Main Road TOWN CLERK =_«� P.O.Box 1179 a REGISTRAR OF VITAL STATISTICS0Southold,New York 11971 �� MARRIAGE OFFICER � � Fax(516)765-1823 ® i RECORDS MANAGEMENT OFFICER � � sel. 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. 3368-R Residential X Non-Residential Fee $ 10.00 New Existing X Name Of Owner VAN DYNE, MARTIN Mailing Address 1 4110 NASSAU POINT ROAD Mailing Address 2 City St Zip CUTCHOGUE NY 11935-0000 Property Address 1 4110 NASSAU POINT ROAD Property Address 2 City St Zip CUTCHOGUE NY 11935-0000 Owner Telephone No. 516-734-7511 • Tax Map No. section 111 .00 block 8 lot 3.000 Cross Street WUNNEWETA ROAD Issue Date: 7/28/95 Judith T. Terry Southold Town Clerk (TOWN SEAL) OFP'ICE'JOF THE TOWN CLERK s.�FFO� Town of Southold , ,c31 � Application No. 336r Judith T. Terry, Town Clerk �► . Town Hall, 53095 Main Road a • -� I $10.00 -, Residential P. O. Box 1179 � i �`' $25.00 - Non-Residential Southold, New York 11971 OO Oro/ Telephone j � (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: I/9/) d /�e_ A4r/ it)y / Rdi OWNER MAILING ADDRESS: ,rr(7 6 a • C elV 9R <— OWNER PROPERTY ADDRESS: Sop-) € OWNER TELEPHONE NUMBER: S-1,6 -- 78V- 7C/1 - 3 TAX MAP NO. : Section 11/ Block r Lot CROSS STREET: di6stui pit ea 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.) V/L 41,1‘ '?naQcant RECEIVED BY: k Town erk's Office _ - - ° - DATE: °' „9� - vs,. ,,..,„,.. ,.. . . „ . ._. . , , . I H ott Te-- . , FM tit AD . . , . R (\rascivk Iv-- (9c'-•A.- . , - . . , .....______.„..-------------------, . . , . • . . „ . . ..., . . . , .