HomeMy WebLinkAboutWeissert, William ELIZABETH A.NEVILLE _e 'yd: Town Hall, 53095 Main Road
TOWN CLERK O P.O. Box 1179
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REGISTRAR OF VITAL STATISTICS Al 1 Southold, New York 11971
'F �� Fax(631) 765-6145
MARRIAGE OFFICER 00.
RECORDS MANAGEMENT OFFICER -y�p1 **„.0 Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER •��� S
OFFICE OF THE TOWN CLERK
SOUTHOLD rIVASTITEDOMIRTHESERDSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4101-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner WEISSERT, WILLIAM F.
Mailing Address 1 3440 WELLS RD
Mailing Address 2
City St Zip PECONIC NY 11958-0000
Property Address 1 3440 WELLS RD
Property Address 2
City St Zip PECONIC NY 11958-0000
Owner Telephone No. 631-765-5117
Tax Map No. section 86.00 block 1 lot 13.000
Cross Street MAIN ROAD
Issue Date: 8/17/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK C��FFOU(":
TOWN OF SOUTHOLD �� CO Application No. yi
ELIZABETH A.A.NEVILLE,TOWN CLERK $10.00 - Residential
P.O.BOX 1179
SOUTHOLD,NEW YORK 11971 ,�� $25.00 - Non-Residential
Telephone �j * `#'0•
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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.
Fee $ •
DATE
OWNER NAME: 1;vl c-L-tfrr9 F . W 7J5 J
OWNER MAILING ADDRESS: 3y ca W et-c-5 gO, -n
Rto�/t c p L //
OWNER PROPERTY ADDRESS: 6.-/rvute)
OWNER TELEPHONE NUMBER: L C—
TAX MAP NO. : Section , Block / Lot
CROSS STREET: /1).s. / A-( AG �
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 App ici- ant
RECEIVED BY:
Town lerk's Office
DATE: / 7
0011.11.1.7 1'4 p 1 ft hi
William Weisser
3440 Wells Road
Peconic
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