HomeMy WebLinkAboutEckartz JUDITH T. TERRY „4~� �
Town Hall, 53095 Main Road
TOWN CLERK 0 f P.O. Box 1179
REGISTRAR OF VITAL STATISTICS �� Southold, New York 11971
�� Fax (516) 765-1823
MARRIAGE OFFICER 1
®�� , ®��!` Telephone (516) 765-1801
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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. 1833-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner ECKARTZ, WILLIAM J.
Mailing Address 1 315 SOUND AVENUE
Mailing Address 2
City St Zip PECONIC NY 11958-0000
Property Address 1 315 SOUND AVENUE
Property Address 2
City St Zip PECONIC NY 11958-0000
Owner Telephone No. 516-734-5622
Tax Map No. section 67.00 block 2 lot 6.000
Cross Street MILL LANE
Date Of Last Pump Out 0/00/00
Issue Date: 1/22/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK cvFFO(,r-
Town of Southold .� z
. C' -- Application No. N"- -3
Judith T. Terry, Town Clerk % 4 `' L 1
Town Hall, 53095 Main Road a w '`kx%i 7 $10.00 - Residential
u7 " $25.00 - Non-Residential
• P. O. Box 1179 � �-Za � �
Southold, New York 11971 O ® *` y- ��`�
Telephone *4-0-....
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
or CESSPOOL
Operation Permit No. ‘7-2- -t
"2 -t
Fee $ /0 - 00
DATE
/ , G 2A.
OWNER NAME: l/" /// A1d1. U C/ f-/ T
OWNER MAILING ADDRESS: 3 /f SQ ct Aid ,1- v
,19- c--0 Ai ib / 1Y/ j1 -
OWNER PROPERTY ADDRESS: 3 R a vrd vC
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y
OWNER TELEPHONE NUMBER: 73 `f — 576 D.._. _
TAX MAP NO. : Section ' 7 Block D.-- Lot 6
CROSS STREET: N;:-EZ Yom' O
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool �- New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: // , 7 C/
LOCATION MAP: Must be attached hereto efore permit may be issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
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VA64/1-.
Signature of A 4 - t
Iir
RECEIVED BY:
Town Clerk's Of ice
DATE: C ./ Y2
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PLEASE USE. BOTH SIDES OF THIS SHEET ., . :