HomeMy WebLinkAboutEisenreich, William ,1"oFFO(�co,
tLIZABETH A.NEVILLE �� � y ; Town Hall, 53095 Main Road
TOWN CLERK % o • • P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER +, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER '/Q! Aig 4.,„0 Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER •_ iii.
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4039-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner EISENREICH, WILLIAM & CHRISTIN
Mailing Address 1 9 OREGON DRIVE
Mailing Address 2
City St Zip HUNTINGTON STATION NY 11746-0000
Property Address 1 805 BAY SHORE ROAD
Property Address 2
City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 000-000-0000
Tax Map No. section 53.00 block 3 lot 10.000
Cross Street HERININ BLVD
Issue Date: 7/12/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK
/c0FO
OQApplication No.7/0
)9TOWNOFSOUTHOLD G �F ZABETHA.NEVIIt.F,TOWN CLERK
$10.00 - Residential
P.O.BOX 1179
SOUTHOLD,NEWYORK11971 � $25.00 - Non-Residential
Telephone Oj , l�fi'�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 197j
Fee $ /0, 00
DATE
OWNER NAME: O$0312,VIC-41 ) (Aim •+- N 12�S�N
OWNER MAILING ADDRESS: 9 X0 6- oft/ 1).12Iv'E
ti-un+71W670tJ Smrloo.) ivy
OWNER PROPERTY ADDRESS: $row , Sl 12 AI)
C-k / netyy
OWNER TELEPHONE NUMBER:
TAX MAP NO. : Section S3 Block Lot '0
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential V Non-Residential
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
67,
RECEIVED BY/
Town Clerk's ffice
DATE: %.7// ,(1:0