HomeMy WebLinkAboutRademacher, Claus I�o,O�Osf�f FO�,�OO
ELIZABETH A. NEVILLE ��_ Gid: Town Hall, 53095 Main Road
TOWN CLERK ; H P.O. Box 1179
REGISTRAR OF VITAL STATISTICS 47? Southold, New York 11971
MARRIAGE OFFICER y �1 Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER =_ 701 *a0,'1 � Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ��,,r��
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4081-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner RADEMACHER, CLAUS
Mailing Address 1 136 EAST 73RD ST
Mailing Address 2
City St Zip NEW YORK NY 10021-0000
Property Address 1 350 LAKESIDE DRIVE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 631-765-1705
Tax Map No. section 90.00 block 3 lot 16.000
Cross Street CEDAR POINT DRIVE EAST
Issue Date: 11/30/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
a
OFFICEOF THE TOWN CLERK ��,�C3�FFO(,(�`,"
TOWN OF SOUTHOLD Application No.
LIZABETH A.NEVILLE,TOWN CLERK
:4 $10.00 - Residential
P.O.BOX 1179
CI)SOUTHOLD,NEW YORK 11971 $25.00 - Non-Residential
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Telephone �j � Y►� t'
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE 2V0/
OWNER NAME: C -,k ' A /1,696 ¢yr 2-
OWNER MAILING ADDRESS: /3Sd'/lffd'
/1J 70 es V,,V !t wz/
OWNER PROPERTY ADDRESS: 3 L•e74-c, t ,fo14Th+foLIP 7Ai `f.
y(Q1T C .x ' 2 NI tM7 J
OWNER TELEPHONE NUMBER: X03/ - 7,,r /9vS
tTAX MAP NO. : Section 9D Block 3 Lot
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool 3 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.)
r T
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
CLAUS F.RADEMAL.hr..ri• ARCHTit.-...
136 EAST 73 STREET
NEW YORK•NEW YORE
10021 `
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