HomeMy WebLinkAboutO'Brien ELIZABETH A. NEVILLE ��OF SU(/ry
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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
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Mailing Address 1 338 BLOOMFIELD STREET
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Mailing Address 2 APT 4
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City St Zip HOBOKEN NJ 07030-0000
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Property Address 1 980 LIGHTHOUSE ROAD
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Property Address 2
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City St Zip SOUTHOLD NY 11971-0000
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Owner Telephone No. 631-000-0000
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Tax Map No. section 50.00 block 5 lot 9.100
Cross Street SOUNDVIEW AVENUE
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Issue Date: 10/29/08 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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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