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JUDITH T. TERRY ; E+ Town Hall, 53095 Main Road '
TOWN CLERK p rZ P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
Fax (516) 765-1823
MARRIAGE OFFICER O •
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'� Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3173-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner ENDEMANN, FRED
Mailing Address 1 495 EUGENE ROAD
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 495 EUGENE ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-5441
Tax Map No. section 97.00 block 2 lot 16.003
Cross Street ROUTE 25
Issue Date: 2/04/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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- OFFICE OF THE TOWN CLERK c0FU(,' -
Town of Southold kJ � :. sCQG Application No. &/71(-5
Judith T. Terry, Town Clerk % r{ ' , $10.00 - Residential
Town Hall, 53095 Main Road "
P. O. Box 1179u' _" tY'' $25.00 - Non-Residential
Southold, New York 11971 O -® ' -`".0-1.4
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Telephone oj
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
Crjr 3*
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ �p
DATE .Jf-6V 3
OWNER NAME: IFP—Vz--I) AAQ jjO% E -iAevN
OWNER MAILING ADDRESS: '11 FUG I -Nth ion)
•coo 6-cNI /635
OWNER PROPERTY ADDRESS: S} i;,
OWNER TELEPHONE NUMBER: 73 g`1(/
TAX MAP NO. : Section 1¶7• •3 Block • Lot
CROSS STREET: _
TYPE OF SYSTEM: Septic Tank V I New Existing i/
Cesspool 3 New Existing V
Residential I Non-Residential
LOCATION MAP: Must be •ttached hereto before permit may be issued.
(Locate bui •ing _ • ' em; give north arrow and feet
of distance, approximately, to building and closest road.)
Signature of Applicant
RECEIVED BY: RECEIVED
Town Clerk's Office
FEB 3 1994
_ DATE:
Southold Town Clerk
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