HomeMy WebLinkAboutBirman JUDITH T.TERRY ,
�, •r` k Town Hall, 53095 Main Road
TOWN CLERK • ; ',> P.O. Box 1179
REGISTRAR,OF VITAL STATISTICS ® % j $ Southold,New York 11971
MARRIAGE OFFICER ‘`.414/'" `' ®��1� Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER .1 •el° Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER , .-1-
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3685-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner B I RMAN, PAUL
Mailing Address 1 260 SUNSET WAY
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 260 SUNSET WAY
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-2081
Tax Map No. section 91 .00 block 1 lot 6.000
Cross Street CEDAR BEACH ROAD
Issue Date: 9/04/97 Judith T. Terry
• Southold Town Clerk
• (TOWN SEAL)
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OFI:,VCE "OF THE TOWN CLERK c�VFF� A- - _
Town of Southold � CDS Application No. 3685
Judith T. Terry, Town Clerk ; . $10.00 - Residential L.""Town Hall, 53095 Main Road
P. O. Box 1179 cn - �' $25.00 - Non-Residential
Southold, New York 11971
Telephone _`U1 `�►��
(516) 765-1801
TOWN OF SOUTHOLD
•
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE tt�u` Jo 1�t9�
OWNER NAME: PIVL (2-44
OWNER MAILING ADDRESS: ,(y0 .1'fJ„.0f wA`
OWNER PROPERTY ADDRESS: 0266 SOPSL— WA/
„re elifoLt
OWNER TELEPHONE NUMBER: (fit )
TAX MAP NO. : Section L+1 Block 431.-1 _6 Lot
CROSS STREET: CEW' Q_ 2®
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:
Town Clerk's Office
DATE:
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