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ELIZABETH A.NEVILLE ® .. • Town Hall, 53095 Main Road
TOWN CLERK 2 P.O. Box 1179
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��, Southold,New York 11971
REGISTRAR OF VITAL STATISTICS ‘--#4 Fax(516) 765-1823
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MARRIAGE OFFICER ' � ����0%./ Telephone (516) 765-1800
RECORDS MANAGEMENT OFFICER - ,�
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3812-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner HINDERLITER, CATHY
Mailing Address 1 P. O. BOX 184
Mailing Address 2
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City St Zip MATTITUCK NY 11952-0000
Property Address 1 2475 COX NECK ROAD
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-9452
Tax Map No. section 113.00 block 7 lot 9.000
Cross Street BERGEN AVENUE
Issue Date: 9/11/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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OFFI OF T
EILE TOWN CLERK H
TOWN OF SOUTHOLD
, 5 CSG Application No. 38/ 02-)
ELIZABETH A.NEVIIJ.F„TOWN CLERK $10.00 - Residential
P.O.BOX 1179 a
•SOUTHOLD,NEW YORK 11971 *.$ $25.00 - Non-Residential
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-- Telephone : ,( •k`15•0 eto
IP I
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE e/M0
OWNER NAME: ( '
OWNER MAILING ADDRESS: 00 itc 1.R-9
"$ \-v oz. k(c167_
OWNER PROPERTY ADDRESS: 0t-( ) c (ac P
OWNER TELEPHONE NUMBER: ' c2g 9 q. 2.
TAX MAP NO. : Section Block (k5 - Lot "7 , y'
CROSS STREET: y ;Q-L)
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing 2<._
Residential x 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.)
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Sigr ature of Applicant
RECEIVED BY:
RrEaerk's Office
DATE: SEP 21999
Southold Tow, Mt •