HomeMy WebLinkAboutHeimink '��®y
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i Town Hall, 53095 Main Road
-' ' �® ,1 P.O. Box 1179
�`V.4 Southold, New York 11971
JUDITH T.TERRY FAX(516)765-1823
TOWN CLERK TELEPHONE(516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1468-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner HEIMINK, ANTHONY
Mailing Address 1 1780 WESTVIEW DRIVE
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 1780 WESTVIEW DRIVE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-4316
Tax Map No. section 107.00 block 7 lot 20.000
Cross Street BROWER ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 5/23/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK ®cw�FO(/rC' tq/
-51
Town of Southold Application No. t�
Judith T. Terry, Town Clerk aq''.,
Town Hall, 53095 Main Road } $10.00 - Residential
P. O. Box 1179 ul `n �"�i'ig
�,�h�, � $25.00 - Non-Residential
Southold, New York 11971 O .:V�J
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /b , [r°
DATE —'?d
OWNER NAME: 4/071-1-0 JJ /V,1/ \j/
OWNER MAILING ADDRESS: /IRO teU/60,.ba_,
V i- r vcK AJLV. /(f,579--
OWNER
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OWNER PROPERTY ADDRESS: ‘-C-4111 C.--
OWNER TELEPHONE NUMBER: zg7 4516
TAX MAP NO. : Section/O 7 Block 7 Lot O
CROSS STREET: DOZOWC2.
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool 'f New Existing 1
Residential Y Non-Residential
DATE OF PREVIOUS PUMP-OUT: ;z-----/q- 90
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.)
•
Signa re of Applicant
RECEIVED BY:
A Lo n Clerk's Office
DATE: MAY 21, 1990
£45-r
1.5o0
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