HomeMy WebLinkAboutChristensen (2) JUDITH T.TERRY �� 49: 0,4 Town Hall, 53095 Main Road
TOWN CLERK
; c4i5 r a ; P.O. Box 1179
- 119
REGISTRAR OF VITAL STATISTICS 4. � Southold,New York 11971
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MARRIAGE OFFICER 4 •,-*4' a,- js Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER . j x gad 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. 3724-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner CHRISTENSEN, WILLIAM AND JEAN
Mailing Address 1 2300 GLENN ROAD
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 2300 GLENN ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-9178
Tax Map No. section 78.00 block 2 lot 40.000
Cross Street MAIN BAYV I EW ROAD
Issue Date: 11/12/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK �cvFFO(,r�'-
Town of Southold � CQG:\ Application No. 3 7e1.___Y
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road $10.00 - Residential
P. O. Box 1179 v' : ' i ;' $25.00 - Non-Residential
Southold, New York 11971
Telephone oji
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE II- 7 - ?7
OWNER NAME: (4U (IR nl C HP, 112-11115 -01/
OWNER MAILING ADDRESS: `a',36;,. G eif/N D
. 6 E.) .tiA vt•D r iV / rq7
OWNER PROPERTY ADDRESS :
OWNER TELEPHONE NUMBER: 5-74 "742✓^ gid (7)g) 3 47.-g')"
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TAX MAP NO. : Section •Ei7gd 6 D Block 0 o (9,6 Lot 4 L7 (916c)
CROSS STREET:
TYPE OF SYSTEM: Septic Tank / New Existing
Cesspool V New Existing
Residential Non-Residential
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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 Applicant
RECEIVED
RECEIVED BY:
Town Clerk's Office •
NOV'13 1997
DATE:
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SURVEYED FOR:-4ij7WONy `(/. c:e Cd,eOCyN -,e) ZEG.aG/O
LOCATED AT SOVT,W/OG[W . , TOWN-OF'Sour/,/oC0 , SUFFOLK COUNTY'N.Y.
LOT 2.3
MAP OF WEST G-.PEE, E'S7-•47-E5 -• - "- , CO. CLK. NO. c-35'-1 ' FILED 4UG./9.,/9G.3
SCALE 1" =,...F0' . I
SUFFOLK CO. TAX MAP DATA:-
DIST./6100 SEC. 02:5!00 /�/ 20"OD'!�/ - .oc ciaG 227.00 -
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SURVEYED /.,74y f29 1986 BY -
WILLIAM R. SIMMONS JR.
- P/0 BOX 377
ay_ ^_�� /� JAMESPORT, L.I., N.Y. 11947
/7/ ( w,, - FILE NO /O 4(29 PAGE Z3 GRID.4'47
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