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Home My WebLink AboutHerrmann a' JUDITH T.FERRY Town Hall, 53095 Main Road TOWN�Y:LERK ; P.O. Box 1179 REGISTRAR OF VITAL STATISTICS J Southold, New York 11971 MARRIAGE OFFICER Fax Fax (516) 765-1823 i! Telephone (516) 765-1801 EZn OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 1879-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner HERRMANN, EDWARD & EILEEN Mailing Address 1 P.O. BOX 1166 Mailing Address 2 City St Zip MATTITUCK NY 11952-0000 Property Address 1 1000 MARLENE LANE Property Address 2 • City St Zip MATTITUCK NY 11952-0000 Owner Telephone No. 516-298-4327 Tax Map No. section 1 .44 block 2 lot 40 Cross Street ROUTE 25 Date Of Last Pump Out 0/00/00 ---- . t -- • Issue Date: 4/13/92 Judith T. Terry ; ,, Southold Town Clerk (TOWN SEAL) • IIS''' OFFICE OF THE TOWN CLERK cl)V �. Town orf Southold •. CQ ' , Application No. Judith T. Terry, Town Clerk 4(4'° Town Hall, 53095 Main Road �, ,3 � ; u C $10.00 - Residential .� p. 0. Box 1179 (( l ' 0- k $25.00 - Non-Residential Southold, New York 11971 O O�,•�t% Telephone o?i '' • .' (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. le-27 � v0 Fee $ DATE P02U- 9 - s2 OWNER NAME: E o U,D 4 \2 l' l 4- Ni V. 4-L f2(a.yy\1(A "1.3 N OWNER MAILING ADDRESS: 1000 }AytRL.�=yv C— !,°s - , © .A\-10 )M\NTY / tY, 1l ci SZ OWNER PROPERTY ADDRESS : \ 11-c� C�— OWNER TELEPHONE NUMBER: 5l (0 2 c( B- 43Z1 TAX MAP NO. : Section 1 4 4 Block 2 Lot 4'v CROSS STREET: 953. 3(0 TYPE OF 'SYSTEM: Septic Tank New Existing Cesspool ✓ New Existing ✓ Residential Non-Residential DATE OF PREVIOUS PUMP-OUT: L2.1 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.) ' v_ "� Vim'J G� \�\'�}`• V VIS\J/VV�/t� Signature of Applicant RECEIVED BY: own Clerk's Office DATE: l L 9 F - 9rs3.3� , 75 � -- -, _ -- ____ In' _ . ' ----, -. . 7 '----;: . 1 , ,, „ . . H _. - - - � -o �• , 24I, . , 1 . . , . ,. , 0 . . , , , , . . . .r. . „._ . , , , . , . . , . . , . , . , , . _ . . .. . , ,. 0 - . ,, . e 7S . , • , . . , , -,7 _� , ®"e EL. ,',e.v HE WANW, f®,875 '�_FT _ • a5- mac.