HomeMy WebLinkAboutDemel (2) FO�/�coG
ELIZABETH A.NEVILLE o y� Town Hall, 53095 Main Road
TOWN CLERK P.O.Box 1179
Southold,New York 11971
REGISTRAR,OF VITAL STATISTICS �?,- � �� Fax(631) 765-6145
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER Telephone(631) 765-1800
southoldtown.northfork.net
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
OPERATION PERMIT
CESSPOOL or SEPTIC TANK :
Residential @$10—K or Non-Residential @$25 Application No.
Permit No. 9 2—
Owner Name m }r c D6,Y)e
Owner Mailing Address J`�O m ( Cie Q �
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Owner Property Address 14r O rnJ 1 C-ee L a uQ s
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Owner Telephone No.
Tax Map No: f 6 Dd Section S Block Lot
Cross Street
Please check each that applies: New Construction -
Alteration to Existing System
Residential _Non-Residential
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. (Locate
building and system; give north arrow and approximate distance in feet from system to building
and closest road. New construction may submit copy of survey with SCHD approval.)
Sign tore of Applicant Date
Received by: J•�
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1 ELIZABETH A. NEVILLE MMCF yi. 'f ,
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Town Hall 53095 Main Road
jTOWN CLERK th `i4,,;; � x: N P.O.Box 1179
Southold New.York 11971
REGISTRAR OF VITAL STATISTICS ,�.• ��� ' ;i Fax(631)765-6145
MARRIAGE OFFICERr Telephone(631)765-1800
} RECORDS MANAGEMENT OFFICER ' ' www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANKOR CESSPOOL
Operation Permit No. ' 4512 r X Residential _Non-Residential
Fee$ 10.00 _New X Existing
Name of Owner: Marc Demel
Mailing Address: 1450 Mill Creek Drive
City St Zip: Southold NY 11971
Property Address: 1450 Mill Creek Drive
City St Zip: Southold NY 11971
Telephone No. 516-509-6283
Tax Map No. Section 51.00 Block 06.00 Lot 27.00
Cross Street Grove Drive
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Issue Date: 12/6/2018
Elizabeth A. Neville
s Southold Town Clerk
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