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HomeMy WebLinkAboutBreese -- 4 ,�i JUDITH T.TERRY �� y:� Town Hall, 53095 Main Road TOWN CLERK ; _ P.O. Box 1179 ft? Southold,New York 11971 REGISTRAR OF VITAL STATISTICS `. ®� �� Fax(516) 765-1823 RECORDS MANAGEMENT OFFICER 1 [ % MARRIAGE OFFICER = �� r�il°� 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. 3402-R Residential X Non-Residential Fee $ 10.00 New Existing X Name Of Owner BREESE, A. ELAINE AND SYDNEY Mailing Address 1 1700 CEDAR BEACH ROAD Mailing Address 2 City St Zip SOUTHOLD NY 11971-0000 Property Address 1 1700 CEDAR BEACH ROAD Property Address 2 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 516-765-3644 Tax Map No. section 89.00 block 2 lot 4.000 Cross Street MAIN BAYVIEW ROAD Issue Date: 10/30/95 Judith T. Terry Southold Town Clerk (TOWN SEAL) ,, OsYg�FFO�,�00 JUDITH T.TERRY ����� �� Town Hall, 53095 Main Road TOWN CLERK ; y 2 P.O. Box 1179 •v t Southold,New York 11971 REGISTRAR OF VITAL STATISTICS O MARRIAGE OFFICER \*S ®��1� Fax (516),765-1823 RECORDS MANAGEMENT OFFICER . of 4 �800 Fax (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. 3402-R Residential X Non-Residential Fee $ 10.00 New Existing X Name Of Owner BREESE, ADELAIDE AND SYDNEY Mailing Address 1 1700 CEDAR BEACH ROAD Mailing Address 2 City St Zip SOUTHOLD NY 11971-0000 Property Address 1 1700 CEDAR BEACH ROAD Property Address 2 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 516-765-3644 Tax Map No. section 89.00 block 2 lot 4.000 Cross Street. MAIN BAYV I EW ROAD Issue Date: 10/30/95 Judith T. Terry Southold Town Clerk (TOWN SEAL) t n p •w „ "I OFFICE OF THE TOWN CLERK �VFQ Town of Southold Q� C Application No. 6;T6.410,a� = OG=� Judith T. Terry, Town Clerk �` t Town Hall, 53095 Main Road m $10.00 - Residential f/ P. O. Box 1179 to �`' $25.00 - Non-Residential Southold, New York 11971 4 *.$ Telephone 01 j j Or/ ir (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT RECEIVED APPLICATION -- OCT 2 3 1995 for Southold Town Clerk OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ DATE 23 pr. /• :1-____ OWNER NAME: AL 5 ppl4.-1 5fj,,A+65,>" OWNER MAILING ADDRESS: 17 0 0 014,4, , 6 c—&1j- 12, 'D S."611-31 4tio7 N� !( q7f OWNER PROPERTY ADDRESS: 1704 <„,, gc-'5, AC, - R.& A ] �1 ' , /t 47/ OWNER TELEPHONE NUMBER: 6�f(Q ) TAX MAP NO. : Section 9 Block X Lot A CROSS STREET: tittiti g14y✓ricr17 /Z TYPE OF SYSTEM: Septic Tank New Existing ,Cesspool k 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.) Siignatudre of p nt RECEIVED BY: a Tow C erk's Office DATE: f© ' � ' j 5 C£-DA t 8 EACH c /9 .c) -A is) i,1 1 --------i--- ---- --------- ,^\ /04.0 v 1pd. 00 ,� ....._` J ~. U o ti C) c} 1 h D o XI th i+ • 1NI ti ! N tti N A tv ; II i IN . / N � c 1 II) til 4-4,A e Al/ ts • - i‘ N IV , \ a wr o ( - .. _ r_ - J . --- .. -1. . 1 . f ;1 t1 _ i o o.o % /v o. Dv -- S, 2 3 °6 7 �o "w, # -- l A, v) 0�� ti,1 % � 0 ) f4 t