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HomeMy WebLinkAboutButterworth ELIZABETH A.NEVILLE ,���� y Town Hall, 53095 Main Road TOWN CLERK i ® P.O. Box 1179 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS ‘• �'�� Fax(516) 765-1823 MARRIAGE OFFICER1 RECORDS MANAGEMENT OFFICER ®1 4:61.6 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. 3774-R Residential X Non-Residential Fee $ 10.00 New Existing X Name Of Owner BUTTERWORTH, BARBARA Mailing Address 1 P. O. BOX 60057 Mailing Address 2 City St Zip PALO ALTO CA 94306-0000 Property Address 1 12030 NEW SUFFOLK AVENUE Property Address 2 City St Zip CUTCHOGUE NY 11935-0000 Owner Telephone No. 516-734-6680 . Tax Map No. section 116.00 block 6 lot 10.001 Cross Street MOORES LANE Issue Date: 3/17/98 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) OFFICE OF THE TOWN CLERK C3�FFUL4 •�" _ 7 7 L' Application No. 3 TOWN OF SOUTHOLD A��. fY �G pp ' ELIZABETH A.NEVILLE,TOWN CLERK =ti ;.x J �7 $10.00 - Residential P.O.BOX1179cn SOUTHOLD,NEW YORK 1 I97I *a* 411.4 4a $25.00 - Non-Residential Telephone - 1 (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. - Fee $ IQ,Q 0 • DATE 4/0 (0 OWNER NAME: irvaA &Armord1 OWNER MAILING ADDRESS: ro, D ' 6005 OWNER PROPERTY ADDRESS: 'f7,073-0 ®Irk 5q41&-- % Cafr OWNER TELEPHONE NUMBER: 13,f.4bso0/1- Ir - TAX MAP NO. : Section Block Lot CROSS STREET: 1oorA kge ;TYPE;,OF ,SYSTEM: Septic Tank Z New Existing Cesspool % New Existing Residential V Non-Residential ./<:- -OCA' ION AP: 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.) qtl �� _ - -/L Dr (� Signature of App icant RECEIVED; BY • • acI' • Town Clerk's Office DATE: - - MAR . 6 1998 eour old Tom©1,52:K Vir N'&& 54,144ifAve / Havre 1