HomeMy WebLinkAboutBurns' a
111 OfFOLt
ELIZABETH A.NEVILLE may® Coe:t ; Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
;: ae Southold,New York 11971
REGISTRAR OF VITAL STATISTICS % /I Fax (516) 765-1823
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER #, ,®i'��� Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER •.'i
of
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3838-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner BURN JR., PAUL R.
Mailing Address 1 275 TOWN HARBOR LANE
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 SAME
Property Address 2
City St Zip 00000-0000
Owner Telephone No. 516-765-2611
Tax Map No. section 63.00 block 4 lot 6.000
Cross Street ROUTE 25
/,
Issue Date: 12/21/98 Elizabeth A. Neville
Southold Town Clerk
•
(TOWN SEAL)
}
•f#
OFFICE OF THE TOWN CLERK CI\FFO(,r - p- S/
TOWN OF SOUTHOLD `, CO�► Application No.�a
. ELIZABETH A.NEVII.1.F,TOWN CLERK $10.00 - Residential
P.O.BOX 1179
SOUI'HOLD,NEW YORK 11971 *.$ $25.00 - Non-Residential
- Telephone _4' Y► .'
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ 10 -00
DATE 1 a-9 -�
OWNER NAME: PCwJ R. Clue 10 S
OWNER MAILING ADDRESS: a15
s bu,44. k L I-is i
OWNER PROPERTY ADDRESS: CJ\ G -Q_,
OWNER TELEPHONE NUMBER: cj - 1(O5
TAX MAP NO. : Section (03 Block 'I Lot
CROSS STREET: R - , a6 0,10,..cLA—V1/4W44,1
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.)
Signature of A li t
g PP
RECEIVED BY:
Town Clerk's Office
DATE:
t"
TOW N H Z OR LANE.
s;. i
•
ti, t
f.
co
N. . z
0 /, 8I" '
RI 4 LL
!t 1
oil
ts.-..M . ;
I
Pi .
ol
81 .
t 0 In
1
it,
` ' U
'
! _ �`.``
V
yw
O
sem, .