HomeMy WebLinkAboutCochrane , •
JUDITH T.TERRY � � � Town Hall, 53095 Main Road
TOWN CLERK ; P.O. Box 1179
tSouthold,New York 11971
REGISTRAR OF VITAL STATISTICS `®� ��'�1� Fax(516) 765-1823
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER .� $i th 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. 3608-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner COCHRANE, HAROLD C.
Mailing Address 1 P. O. BOX 663
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 1065 BRIGANTINE DRIVE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-1138
Tax Map No. section 79.00 block 4 lot 52.000
Cross Street NORTH BAYVIEW ROAD
Issue Date: 4/15/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE T9WN CLERK ••c�V �FD(e "-
Town of Southold �„ CaN., Application No.3co 0 r
Judith T. Terry, Town Clerk �� ; y
Town Hall, 53015 Main Road Ftp . 4.4''•� .G I $10.00 - Residential
P. O. Box 1179 %;;;;$'
;:fa, s Y `
$25.00 - Non-Residential
Southold, New York 11971 Of S
Telephone o •
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(516) 765-1801
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE ppi,) 14±h ) q77
OWNER NAME: 4,0L C. Gr./It/at-1F'
OWNER MAILING ADDRESS: )(-),/,5 -B,1c,j4r-i,- 06 Box 6A3
-i c c57_4)-)ifjc)., )V [ 1971 .
OWNER PROPERTY ADDRESS : ,(, F 0 0_6)5
OWNER TELEPHONE NUMBER: 1---376 '7y 5- J13g
TAX MAP NO. : Section 7 Block 4 Lot ��
CROSS STREET: ill,(1- 4.-- p,
TYPE OF SYSTEM: 'Septic Tank New Existing
Cesspool 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.)
Signature of Applicant
,
RECEIVED BY: i
' ' Town, Clerk's Office
DATE: P / •T .
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