HomeMy WebLinkAboutBarker (5) ILII®4004
JUDITH T.TERRY
w : Town Hall, 53095 Main Road
TOWN CLERK - _ k t P.O.Box 1179
,�� Southold,New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER �e� ti ��/ Fax(516)765-1823
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RECORDS MANAGEMENT OFFICER : d id 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. 3417-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner BARKER, WILLIAM L. JR.
Mailing Address 1 275 BUNGALOW LANE
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 275 BUNGALOW LANE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-4204
Tax Map No. section 123.00 block 3 lot 5.000
Cross Street MARRATOOKA ROAD
Issue Date: 12/12/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OF.FICE-OF THE TOWN CLERK sS��FU(,rj�
Town of Southold �� CQG=� Application No3 T/• 7
Judith T. Terry, Town Clerk 6� • y.�
Town Hall, 53095 Main Road $10.00 - Residential
P. 0. Box 1179 cr) $25.00 - Non-Residential
Southold, New York 11971 Obi 0���`
Telephone 0.( jt I�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
r. DATE
OWNER NAME: YV ) L. //9/1n 4, �}gkERI TR.
OWNER MAILING ADDRESS: :-, 2,5' BVn6 ,64o W h SNE.
Nl oT1"(7J vck. Al ! 1 9 S7--
- OWNER PROPERTY -ADDRESS: Z9`1yh;1=
OWNER TELEPHONE NUMBER: 2.9 32- LJ z o y
TAX MAP NO. : Section / 73 Block 3 Lot S
• CROSS STREET: /Y) 61 /T R orb o,(JR o ra
TYPE. OF SYSTEM: Septic Tank - New Existing
t.
Cesspool V New Existing
Residential V 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.)
T36c/11' ,/,_ .
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE: • •
4 I