HomeMy WebLinkAboutConway „ 3141 FVOL/re�._-
JUDITH T. TERRY k r ;- Town Hall, 53095 Main Road
TOWN CLERK '`® F FP.O. Box 1179
gsr% Southold, New York 11971
REGISTRAR OF VITAL STATISTICS cop,” 4% Fax (516) 765-1823
MARRIAGE OFFICER �® l�' Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER ® � i1.'
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. 3232-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner CONWAY, JOSEPH M.
Mailing Address 1 4395 HORTON LANE
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 4395 HORTON LANE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-3048
Tax Map No. section 54.00 block 7 lot 21 .001
Cross Street OLD NORTH ROAD
Issue Date: 8/05/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
„ ,
OFFILF ,� THE TOWN CLERK ocl\VMMir
Town of Southold �Q 0 , re,,-- Application No. 3.25
_ Judith T. Terry, Town Clerk _
Town Hall, 53095 Main Road ',w '' t --41 $10.00 - Residential `�
P. 0. Box 1179 CS) yam=k` :44,7 ”
i ;' $25.00 - Non-Residential
Southold, New York 11971 O `cb,a`''`=" - Q-$
40
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Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for _ . - . . -- - -- .
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. d
Fee $ fid) v ,
T
DATE �
d----/
OWNER NAME: J b S- &P k M ea A (,-) -2';- ''t
OWNER MAILING ADDRESS: . W-3 ct Ct 6(Ar CI i A & it C>
'h ,e47111 6 1- 2c - ,Ll l 1 S 7/
OWNER PROPERTY ADDRESS: j-' A err
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OWNER TELEPHONE NUMBER: 7 ' / G 1(
TAX MAP NO. : Section S y Block 7 Lot c
CROSS STREET: Pz7/ .
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: (-./(-)./(j
Town Clerk's Office -
DATE: F&/ 7 y
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