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1 ® Town Hall, 53095 Main Road
JUDITH T. TERRY _ _• �,
P.O. Box 1179
TOWN CLERK c )
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER � ® �'•4 Fax (516) 765-1823
"a �� �. 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. 1952-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner HEMPEL, WILLIAM JR. & WIFE
Mailing Address 1 P. O. BOX 535
Mailing Address 2
City St Zip EAST MARION NY 11939-0000
Property Address 1 920 BAYV I EW DRIVE
Property Address 2
City St Zip EAST MARION NY 11939-0000
Owner Telephone No. 516-477-2055
Tax Map No. section 37.00 block 5 lot 8.000
Cross Street DOGWOOD LANE
Date Of Last Pump Out 0/00/89
Issue Date: 7/28/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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