HomeMy WebLinkAboutDetrich isois
4°1°4fitir
gra Town Hall, 53095 Main Road
�
P.O. Box 1179
sit ��00°� Southold, New York 11971
JUDITH T.TERRY TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 695-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner DETRICH, DAVID A.
Mailing Address 1 BOX 107
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 WESTVIEW DRIVE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-9692
Tax Map No. section 107 . 00 block 7 lot 19.000
Cross Street BROWER ROAD
Date Of Last Pump Out 0/00/86
Issue Date: 5/11/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK c�\\FFair
Town of Southold � CQG', Application No.
i
Judith T. Terry, Town Clerk , ' i► •
Town Hall, 53095 Main Road �_ Residential
C7 �.;.. .'..r.qtr,__
P. O. Box 1179 u' 4`k �` "M ' Non-Residential
Southold, New York 11971O ®c` i''
Telephone 0.(
(516) . 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. (
Fee $ fa
DATE Y
OWNER NAME: 9/9-0 7 /9- r/ / /?,/l e//
OWNER MAILING ADDRESS: t9 )( g.) 7
/21-X"r/T'PC4‹ /17-y 1/96'x.
OWNER PROPERTY ADDRESS: /=, '%i//is W' pig
fygi--7"/Tt'6>< / ,// m5-z_
OWNER TELEPHONE NUMBER: -3W - 7/5/- 9 p z
TAX MAP NO. : Section' Jo 7 Block 7 Lot 1,
CROSS STREET: 1 4 ()Lt/F
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ,t// New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: 0 G%0e R- n, / 51
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.)
Signature of Applicant
RECEIVED BY7 .
n flerk's 'Office
DATE: MAY 111988
Town Clerk Southold
�2 7