HomeMy WebLinkAboutHerrmann (2) .-
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ii E m i Town Hall, 53095 Main Road
11 ��;i P.O. Box 1179
,1; �� ,s�, ���% Southold, New York 11971
JUDITH T.TERRY -`.�_ `�s r; TELEPHONE
TOWN CLERK (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. 3587-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner HERRMANN; PHILIP
Mailing Address 1 1645 EAST GILLETTE DRIVE
Mailing Address 2
City St Zip EAST MARION NY 11939-0000
Property Address 1 1645 EAST GILLETTE DRIVE
Property Address 2
City St Zip EAST MARION NY 11939-0000
Owner Telephone No. 516-477-2342
Tax Map No. section 38.00 block 4 lot 24.000
Cross Street MIDLAND PLACE
Issue Date: 2/11/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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fir • •i.
OFFaCE OF THE TOWN CLERK COMA'
Town of Southold Application No:
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road $10.00 - Residential
P. O. Box 1179 u' ' z' $25.00 - Non-Residential
Southold, New York 11971
Telephone l 0
p
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3
to"
Fee $ 1 0
• DATE - l )i fri7
OWNER NAME: / /V/�,'L/
OWNER MAILING ADDRESS: / /,5---( / Z57 /7,e, '4
A4767,- ti,y //9Y
OWNER PROPERTY ADDRESS! ,/‘.h"5 4 46T" /L�&l`Tc_ /7/e/ Y�
�49 i7
/1 /9 ie./0x; ,'Z / /1 Z'35)
OWNER TELEPHONE NUMBER: 522 - 4/77 Z3 `/0
TAX MAP NO. : Section 36 Block 41 Lot . 24
CROSS STREET: /W1/Z,/oZ 7L9
TYPE OF SYSTEM: Septie-mak V New Existing i� •
Cesspool t New Existing v
Residential I- Non-Residential
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.)
nature of Applicant
RECEIVED BY: A
/��
Tk's Office
sz DATE: I/
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