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JUDITH T. TERRY ; Town Hall, 53095 Main Road
TOWN CLERK , ® P.O. Box 1179
REGISTRAR OF VITAL STATISTICS � . � �
Southold, New York 11971
MARRIAGE OFFICER � e t� Fax (516) 765-1823
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. 1764-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner HECK, WILLIAM E., JR. AND GAIL
Mailing Address 1 3590 PECONIC BAY BLVD
Mailing Address 2
City St Zip LAUREL NY 11948-0000
Property Address 1 3590 PECONIC BAY BLVD
Property Address 2
City St Zip LAUREL NY 11948-0000
Owner Telephone No. 516-298-8776
Tax Map No. section 128.00 block 6 lot 25.000
Cross Street DELAMR DRIVE
Date Of Last Pump Out 0/00/87
Issue Date: 9/23/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
OFFcCF OF THE TOWN CLERK �FFOZA-
Town,{ of Southold �� • CQG' , Application No. /74,9
getf
Judith T. Terry, Town Clerk ,
Town Hall, 53095 Main Road -4 I $10.00 - Residential
P. O. Box 1179= VI
3 $25.00 - Non-Residential
Southold, New York 11971
Telephone �� NPO '•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
REMED APPLICATION
SEP 221981 for .
town Cid Sae OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. T]. 4,1
' Fee $ /o . 0-0
DATE -56,121—km 6"- / ' (7y
OWNER NAME: 1/1414N1 , G41 L- G�ClC J .
OWNER MAILING ADDRESS: 55^11) , �co/y/( glityI -v/
1-0-✓1444—
OWNER
44EOWNER PROPERTY ADDRESS: 5gN,L - -
OWNER TELEPHONE NUMBER: (476) Q77,6 '
TAX MAP NO. : Section Block Lot `g
CROSS STREET: PEL04a
TYPE OF SYSTEM: Septic Tank ,C New Existing x = •
-- Cesspool New Existing - "
Residential Non-Residential .
DATE OF PREVIOUS PUMP-OUT: t9,"-06 g )4/14-5 //' 'O
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.)
Sy)
di
Signature of App icant
RECEIVED BY: eAr_____ffeevila..0-010.ej
rk's Office
DATE: SEP 23 1991
Town Cie* Southoid •
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