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HomeMy WebLinkAboutClark ®c UL/Q , . JUDITH T. TERRY ` Town Hall, 53095 Main Road TOWN CLERK a ,Z P.O. Box 1179 U' Southold, New York 11971 REGISTRAR OF VITAL STATISTICS Fax (516) 765-1823 MARRIAGE OFFICER 47 zO ."��� Telephone (516) 765-1801 RECORDS MANAGEMENT OFFICER ®1 � °. FREEDOM OF INFORMATION OFFICER �� i,�/0 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 3196-R Residential X Non-Residential Fee $ 10.00 New X Existing Name Of Owner CLARK, ROGER AND COLLEEN Mailing Address 1 P. O. BOX 279 Mailing Address 2 City St Zip GREENPORT NY 11944-0000 Property Address 1 TUTH I LL ROAD EXT. Property Address 2 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 516-477-9733 Tax Map No. section 55.00 block 6 lot 15.053 Cross Street BOISSEAU AVENUE Issue Date: 5/19/94 Judith T. Terry Southold Town Clerk (TOWN SEAL) • OFFICE OF THE TOWN CLERK c��FFO(,(��'- Town of Southold � CQ ' Application No 3 /9 , Judith T. Terry, Town Clerk , .'' 1r y Town Hall, 53095 Main Road r.� ...C. $10.00' - Residential P. O. Box 1179 Tt_ ��g $25.00 - Non-Residential Southold, New York 11971 O *-$ Telephone hyo .�o .• Telephone j (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT __PP{ !CATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ /0. c7 DATE YAV Ay OWNER NAME: -(L3 (-O LIFE-A.) C-Ln1'Lk: OWNER MAILING ADDRESS: fo (30.>< 7-7 1Le&yf &T tJ / 119LiV OWNER, PROPERTY ADDRESS: A-6/lb A-6/ ei7 (1 z 6c1- 617) OWNER TELEPHONE NUMBER: 4/77 ^ q7 33 TAX MAP NO. : Section �S--- Block Lot / CROSS STREET: 7 nsSSE/h TYPE OF SYSTEM: Septic Tank New >c Existing Cesspool New Existing Residential Non-Residential i 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.) ignature of Applicant raJ • RECEIVED BY: O' • rI - °° • ►=lerk's Office DATE: APR- 2 5 1994 Town Clerk Southold' . , - • . .. \ 1 , -10 \ . . . .... _ - , , . . , , . . , . , • . , . . „ . , . . ' - „ , , ;.- , .....,. -.., 4.t.:: • , .:- , , ,„ . .... . , ,,, . , - . ,, •..... -• . , , - , . - - . ,. . ,.., „,;• ,, -,- . . . , , . . . -„..., , . . . . , ... . . . . . : - - . , . . , . . . . .... ... . . _ . _ . . . , . . . . . . . . . . .... , ,, . . . .. . . . , .... , . , . . „ . . . . . _, .,... . . „ . .. . , . • . . . . ._ . .. , . . . ... . _ _ . . , . . . . . , . . .... . . . , .,. . , . . . . _ Cc . . . . ... _ , . . , . . . - , . . •,, . , , , , . . , . , .- = • , -. . , . ..-: , -