HomeMy WebLinkAboutBurns (2) I�� OFFO f
ELIZABETH A.NEVILLE ,I�`�® Cy�1` Town Hall, 53095 Main Road
TOWN CLERK ® P.O. Box 1179
y Southold,New York 11971
REGISTRAR OF VITAL STATISTICS '�� Fax(516) 765-1823
MARRIAGE OFFICER \44' ��� Telephone (516) 765-1800
RECORDS MANAGEMENT OFFICER ®� 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. 3796-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner BURNS, ARTHUR
Mailing Address 1 RUTH ROAD
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 RUTH ROAD
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-9536
Tax Map No. section 105.00 block 1 lot 4.000
Cross Street BREAKWATER AVENUE
Issue Date: 7/13/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK icOFU(,(j�'=
Town of Southold �� �Q =� Application No. 379
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road 74 $10.00 - Residential t/
P. O. Box 1179 cry Zi $25.00 - Non-Residential
Southold, New York 11971 1`
O
Telephone *
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(516) 765-1801
TOWN OF SOUTHOLD
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SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
- - - for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE 47"
OWNER NAME: „1GT4 ve.
OWNER MAILING ADDRESS: ED
N.A-r-rE-ruGie_ AP I
OWNER PROPERTY ADDRESS: 71 co (4.74/4-7 )
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OWNER TELEPHONE NUMBER: z98.- 1650
TAX MAP NO. : Section lb5 Block I Lot
CROSS STREET: AVJ14 vL
TYPE OF SYSTEM: Septic Tank New X Existing
Cesspool New X Existing
Residential X 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.)
i //nat .r•• of .plicant
RECEIVED BY: AL
Town..Clerk's Office
DATE: 41/ 979
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