HomeMy WebLinkAboutHiller MI
ELIZABETH A.NEVILLE ® :t ` Town Hall, 53095 Main Road
TOWN CLERK ti Z P.O. Box 1179
V Q 41$ Southold,New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER y'Iii l/
Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER = ,,•° Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER '018
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3817-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner HILLER, MARIE T.
Mailing Address 1 165 BUNGALOW LANE
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 165 BUNGALOW LANE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-8427
Tax Map No. section 123.00 block 3 lot 2.000
Cross Street MARRATOOKA LANE
Issue Date: 9/16/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
o .
OFFICE OF THE TOWN CLERK c.3VFFO(,fr
CQ ' , Application No. 3817
TOWN OF SOUTHOLD , k,.,*:...?4.‘;,i:;x 1 :� $10.00 - Residential ✓
ELIZABETH A. NEVILLE,TOWN CLERK �� ,,
P.O. BOX 1179 : ', '£ t =���; $25.00 - Non-Residential
-SOUTHOLD, NEW YORK 11971 0 '-..,1}.:.4'r .0
Telephone . 01 , 1 '
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /6,
DATE„--4V-
1-7 /F99'd
•
OWNER NAME: 7) 40 •
OWNER MAILING ADDRESS:#14S- -uJ 0
OWNER PROPERTY ADDRESS: r - / �7. , -# l / 7:_s--.q
OWNER TELEPHONE NUMBER: o� /cg ' P �,7
la3
TAX MAP NO. : Sectio ,...7.3„../.,,?- --...372- Block 3 Lot ,Z.
CROSS STREET- - _,, e-- — / 6C �' " '` ---5
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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.)
—7 --- -.141
7,( -4-PP--- /
Signature of Applicant
RECEIVED BY: --A,.,,,,,k, 6.4._
ToUvn Clerk's Office
DATE: 9-/6,- 78
s
*-)1-0,41