HomeMy WebLinkAboutAhaesy JUDITH T.TERRY =r ': .ik,>r�k Town Hall, 53095 Main Road
® ` P.O.Box 1179
TOWN CLERK �3w r h
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REGISTRAR OF VITAL STATISTICS • `� ' Southold,
MARRIAGE OFFICER � <l��� Fax(516)765-1823
RECORDS MANAGEMENT OFFICER ®� ED Vol 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. 3325-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner AHAESY, ARLENE
Mailing Address 1 P. O. BOX 1
Mailing Address 2
City St Zip GREENPORT NY 11944-0000
Property Address 1 1345 SOUND ROAD
Property Address 2
City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 516-477-0849
Tax Map No. section 33.00 block 4 lot 62.000
Cross Street SOUND DRIVE
Issue Date: 5/04/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK 9S�FFO(,r -
Town of Southold C'
Application Nct
•Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road $10.00 - Residential
P. O. Box 1179 tri . _ `' $25.00 - Non-Residential
Southold, New York 11971
Telephone
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(516) 765-1801
TOWN OF. SOUTHOLD
SOUTHOLD -WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit Nc`- S
Fee $ /O 07
DATE y/02
OWNER NAME: c, o V T�
OWNER MAILING ADDRESS: /-34%x, J)0 -aoi,
71-ci f4./ei-- o a /
OWNER PROPERTY ADDRESS: Gie , ,
OWNER TELEPHONE NUMBER: 5/( o c-"-/ 0j
TAX MAP NO. : Section 33 Block `-71 'Lot 6
CROSS STREET: , � Y t
TYPE OF SYSTEM:' Septic Tank New Existing
Cesspool I. 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.)
Cthez-e
Signatu of Applicant
RECEIVED BY: 6 --
Town Clerk's Office
DATE: c j__// l G�' •
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