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HomeMy WebLinkAboutO'Brien ELIZABETH A. NEVILLE ��OF SU(/ry l TOWN CLERK �� �0 Town Hall, 53095 Main Road REGISTRAR,OF VITAL STATISTICS P.O. Box 1179 MARRIAGE OFFICER CA- Southold, New York 11971 RECORDS MANAGEMENT OFFICER pQ Fax (631) 765-6145 FREEDOM OF INFORMATION OFFICER OIIrcoutY Telephone(631) 00 southoldtown.northfhforork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 4362-R Residential X Non-Residential Fee $ 10.00 New X Existing Name Of Owner DOUGLAS O'BRIEN ------------ ------------------ Mailing Address 1 338 BLOOMFIELD STREET ------------------------------ Mailing Address 2 APT 4 ------------------------------ City St Zip HOBOKEN NJ 07030-0000 --------------- ---- -- ---------- Property Address 1 980 LIGHTHOUSE ROAD ------------------------------ Property Address 2 ------------------------------ City St Zip SOUTHOLD NY 11971-0000 -------------------- -- ---------- Owner Telephone No. 631-000-0000 ------------ Tax Map No. section 50.00 block 5 lot 9.100 Cross Street SOUNDVIEW AVENUE ------------------------------ ----------------------- Issue Date: 10/29/08 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) r • ti ELIZABETH A.NEVILLE ��oF SO(/ryO Town Hall,83095 Main Road TOWN CLERK ~ P.O.Hou 1179 REGISTRAR OF VITAL STATISTICS Southold,New York 11971 MARRIAGE OFFICER s w Fax(631)765-8145 RECORDS MANAGEMENT OFFICER Telephone(691) 765-1.800 FREEDOM OF INFORMATION OFFICER �Cv�aRV southoldtown.northfork.net ul ��, OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 4362-R Residential X Non-Residential Fee $ 10.00 New X Existing Name Of Owner DOUGLAS O'BRIEN ------------------------------ Mailing Address 1 338 BLOOMFIELD STREET ------------------------------ Mailing Address 2 APT 4 ------------------------------ City St Zip HOBOKEN NJ 07030-0000 -------------=------ -- ---------- Property Address 1 980 LIGHTHOUSE ROAD ------------------------------ Property Address 2 ------------------------------ City St Zip SOUTHOLD NY 11971-0000 -------------------- -- ---------- Owner Telephone No. 631-000-0000 ------------ Tax Map No. section 50.00 block 5 lot 9.100 Cross Street SOUNDVIEW AVENUE ------------------------------ ---------------------------------- Issue Date: 10/29/08Elizabeth A. Neville -------- Southold Town Clerk (TOWN SEAL) o�OSU�FO�,��o ELIZABETH A.NEVILLE Town Hall,53095 Main Road TOWN CLERK P.O. Box 1179 H = Southold, New York 11971 REGISTRAR.OF VITAL STATISTICS v+ A� MARRIAGE OFFICER 55 • �'�` Fax (631) 765-6145 RECORDS MANAGEMENT OFFICERTeleP hone(631) 765-1800 FREEDOM OF INFORMATION OFFICER �'� �a southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION OPERATION PERMIT CESSPOOL or SEPTIC TANK Residential @$10 V! or Non-Residential @$25 Application No. �6 Permit No. _35'F4 1K Owner Name 1>a1,-G Owner Mailing Address .3YYF �ome-���7� Owner Property Address �je S� If. Owner Telephone No. Tax Map No: Section Block S Lot Cross Street Please check each that applies: New Construction ✓* Alteration to Existing System Residential V Non-Residential NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. (Locate building and system; give north arrow and approximate distance in feet from system to building and closest road. New construction may submit copy of survey with SCHD approval.) Signature of Applicant bate Receive by: Town Of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 10/29/08 Receipt#: 30217 Transaction(s): Reference Subtotal 1 1 Septic Permit-Operation - Resid. 4382 $10.00 Cash Total Paid: $10.00 Name: O'brien, Douglas 338 Bloomfield Street Apt 4 Hoboken, NJ 07030 Clerk ID: CAROLH Internal ID:4382