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Home My WebLink AboutWren SCLJTHCLD V* TEVINTER DI SPCGAL PERM T CPERATI CN PERM T SEPTI C TANG or CESSPCCL C,per at i on Per ni t W. 4462-R Resi dent i al X Nbn-Pesi dent i al Fee $ 10. 10 New Exi st i ng X Nacre CIF Ower VVEN JCHV E ------------------------------ NbiIing Address 1 P O BCK 1568 ------------------------------ Nslai I i ng Address 2 ------------------------------ O t y St Zip SCL JTHCl-D W 11971-0000 -------------------- -- ---------- Property Address 1 225 H PPCOROVE DR ------------------------------ Property ----------------------------- Property Address 2 ------------------------------ O t y St Zip SCLlTHO_D W 11971-0000 -------------------- -- ---------- Ower Telephone Nb. 631-765-3339 Tax Map Nb. sect i on 66. 00 block 2 1 of 32. 000 ------ --- ------ Cr oss St r eet ROCS ROOD ------------------------------ ------------- -------------------- I --------------------------------------------------------------- I ssue Date: 4/ 16/ 14 B i zabet h A. Nevi I I e -------- Sout hol d Tovm a erk (TCMIV SEAL) r glaFF01�►c ELIZABETH A.NEVILLE ~� � Town Hall,53095 Main Road TOWN CLERK = P.O.Box 1179 REGISTRAR OF VITAL STATISTICSO Southold,New York 11971 MARRIAGE OFFICER 'y • Fax(631)765-6145 RECORDS MANAGEMENT OFFICER ��l �a� Telephone(631)765-1800 FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION OPERATION PERMIT CESSPOOL or SEPTIC TANK Residential @$10 or Non-Residential @$25 Application No. Permit No. Owner Name --1-y h n Lya g Q Owner Mailing Address PO (b /56 k 5;t5<< t'[-60L6 Owner Property Address a�L S /+ i g p a 1512 o nit Z?/L — Sa4gZ:4 iu� Owner Telephone No. Tax Map No: Section��—Block Lot Cross Street :Ro a s 'R-c> Please check each that applies: New Construction Alteration to Exis g System ResidentialNon-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 A p c t Date• Received by: i O�g11FF0[��0 ELIZABETH A.NEVILLE,MMC lbwn Hall,53095 Main Road TOWN CLERK p P.O.Box 1179 y = Southold,New York 11971 REGISTRAR OF VITAL STATISTICS p .� Fax(631)765-6145 MARRIAGE OFFICEROl ��0�' Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SCUTHCLD WSTEVIATER Q SPOSAL PERM T 00NSTRUCII CN CR ALTEPATI CN PERM T SEPTI C TAN( or CESSPOCL Per ni t W. 4210 R Pesi dent i al X Wn-Fesi dent i al Fee $ 10. 00 Sept i c X Oesspool PE%A T I SSIED TQ Imine : M IWL KiAIuER Address 1: P O BOK 683 (3 t y St Z p GiEENPCRr W 11944 Descr i pt on of Pr oposed Const r uct i on or AI t er at i on SAN TARP SYSTEM FCR SI NCLE FAM LY DJ®-.LI NG APPFoAg) AS SM TT® AND AS APPR WM BY TI-E SIFFCLK 00.NY CEPARTMENT CF FEAL.TH SERV CES. FI WL APPFO/AL RECD RED FRC M TI-E SIFFCLK OMNTY HEALTH CEpARTMNT. REF #R10-10-0011 Mrre Cf Omer JCHN & SFPFCN VRN ------------------------------ Mai I i ng Address 1 225 H PPC3;QE DRI VE ------------------------------ ------------------------------ Q ty St Z p SCLMD NY 11971 -------------------- -- ---------- Property --------- Property Address 1 225 H PPCDM E DRI VE ------------------------------ ------------------------------ Q t y St Z p SCUTFICLD W 11971 -------------------- -- ---------- Tax Map W. sect i on 66. 00 block 2 1 of 32.000 Or oss St r eet 104D ------------------------------ Bui I di ng Per ni t N Luber Or oss Ref er ence: --------C�Q�------- I ssue Dat e: 4/07/14 B i zabet h A Nevi I I e -------- Southol d Town Q erk I