HomeMy WebLinkAboutBaker (3) ,N,r. 4.9,Ni,
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ilk Town Hall, 53095 Main Road
1`.\�® P.O. Box 1179
1P� ® ��� Southold, New York 11971
JUDITH T.TERRY ��, r TELEPHONE
TOWN CLERK -- (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3668-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner BAKER, JOHN E.
Mailing Address 1 450 SOUTH HARBOR ROAD
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 450 SOUTH HARBOR ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-6492
Tax Map No. section 75.00 block 3 lot 8.000
Cross Street ROUTE 25
Issue Date: 8/04/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK c�IFO(,rC
Town of Southold �� kh � 0 %,, Application No. 3 6p( /
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Judith T. Terry, Town Clerk $10.00 - Residential x
Town Hall, 53095 Main Road � ;��f, '�:� -'n —
P. O. Box 1179 u-� irk ° ;' $25.00 - Non-Residential
Southold, New York 11971 ® ea, �
Telephone ®,( � �►
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLI CAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE 773/97
OWNER NAME: \.1 EAE. G (130-149.-kr
OWNER MAILING ADDRESS: 4450 $C)4,41 //a cw Rcf
304 0kd / by /199/
OWNER PROPERTY ADDRESS: 5c SO4,4
OWNER TELEPHONE NUMBER: 7(45 51/92
TAX MAP NO. : Section l,5 Block. 3 Lot
CROSS STREET: R 1 c:::2 %.6*--
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential X 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.)
fir Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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