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-JUDITH T. TERRY L Town Hall, 53095 Main Road
TOWN CLERKz. P.O.P.O. Box 1179
REGISTRAR OF VITAL STATISTICS 6rk •• Southold, New York 11971
MARRIAGE OFFICER �® �� Fax (516) 765-1823
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1634-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner DENYS, HARRY
Mailing Address 1 P. O. BOX 386
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 SOUND AVENUE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-4581
Tax Map No. section 121 .00 block 3 lot 3.000
Cross Street BERGAN AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 3/04/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK �S�FFO1J'
Towf of Southold �% -._. C'Q - Application No./6c3q
Judith T. Terry, Town Clerk y .•,
.0 $10.00 - Residential P/
Town Hall, 53095 Main Road E
P. O. Box 1179 cr' " f Y'
.,��,..- .� .�.,�,^-� �i ‘ $25.00 - Non-Residential
Southold, New York 11971 O �.__, �0���,
Telephone _ j
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. %/ 3�
Fee $ /l7
. DATE 3- 47 - q 1
OWNER NAME:• _ '
Harry Denys
OWNER MAILING ADDRESS: I Sound Ave. P.O.Box 386
Mattituck,NY 11952 I
OWNER PROPERTY ADDRESS:
• OWNER TELEPHONE NUMBER: (57 ,) a '- 47/...s-ii. /
TAX MAP NO. : Section i i Block 3 Lot 3
CROSS STREET: y. rvy_) e_..
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing ✓�
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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.)
fignat r of Applica
RECEIVED BY: dc�(�
`f) Clerk's�ibffice
DATE: R41°1°f I
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---------Harry Denys - ---- --I
I Sound Ave. P.0.Box 386
Mattituck,NY 11952
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