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JUDITH T. TERRY % Town Hall, 53095 Main Road
TOWN CLERK ® P.O. Box 1179
grsREGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER _a �,4 Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER iTelephone (516) 765-1801
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FREEDOM OF INFORMATION OFFICER ��� �rrrlI
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3267-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner BYRNES, ROBERT
Mailing Address 1 P. O. BOX 354
Mailing Address 2
City St Zip LAUREL NY 11958-0000
Property Address 1 445 CEDAR LANE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-1122
Tax Map No. section 78.00 block 7 lot 41 .000
Cross Street BAYV I EW ROAD
Issue Date: 10/18/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OF-DICE OF THE TOWN CLERK ���Fp� '-
Town of Southold , ...
® L'Q*A�� Application No. `3`26 7
Judith T. Terry, Town Clerk ;_, , ,, y
Town Hall, 53095 Main Road • -< $10.00 - Residential i_.-------
P.
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P. 0. Box 1179 Jr'' ,, �`' 25.00 -
Southold, New York 11971 p` `t:•':'. . .$ $ Non-Residential
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Telephone 4. �,0"��
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE /Op "2/> 91
OWNER NAME: o 6-$.7 Z / L' 3
OWNER MAILING ADDRESS: To X 3�(.7e-
rnA, U1. /(/, Y /1 57Y'
OWNER PROPERTY ADDRESS: 44‘74S---- eel—DIAD Lr 4A,J •
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OWNER TELEPHONE NUMBER: • ? L� S-- f I c).3_•
y TAX MAP NO. : Section 9 y Block 7 Lot V/
CROSS STREET: .Z171 MI.J (2o x0
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X. 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.)
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Signature of Appli nt
RECEIVED BY:
Town Clerk's Office
DATE:
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