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JUDITH T.TERRY t��,i‘# G'L1 Town Hall, 53095 Main Road
TOWN CLERK ` ® - P.O. Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS Fax(516) 765-1823
MARRIAGE OFFICER `. # Fax
RECORDS MANAGEMENT OFFICER ;'"®,( , .00,0 Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER #,,i1��
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3677-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner HOHL, KENNETH
Mailing Address 1 253 WEST 73RD STREET 8D
Mailing Address 2
City St Zip NEW YORK NY 10023-0000
Property Address 1 MAIN BAYV I EW ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-2366
Tax Map No. section 88.00 block 2 lot 16.000
Cross Street CEDAR DRIVE
Issue Date: 8/13/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK %IFD1,�
Town of Southold �� es Application No ?
Judith T. Terry, Town Clerk �� " . �►
..c
Town Hall, 53095 Main Road g .k $10.00 - Residential
P. O. Box 1179 tds ," : $25.00 - Non-Residential
Southold, New York 11971
Telephone iNd
40 #°
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE /JtI6 ,, (3 j91Z
0
OWNER NAME: /6.-- E7T Ho 741C=...
OWNER MAILING ADDRESS: Z L./Li 7 V rJ 81D
OWNER PROPERTY ADDRESS : /4/9101.1/3 A (re-ti,/ CC(
_couff-- 0 /e/
OWNER TELEPHONE NUMBER: 76 j 2 3 6 6
TAX MAP NO. : Section S'a' Block Lot / 4
CROSS STREET: Gssbil-e 7)aeic' '.
TYPE OF SYSTEM: Septic,Tank „ New Existing
Cesspool New Existing
Residential .V 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.)
Signature of • pplicant
RECEIVED BY: AlL
Town ,Clerk's Office
1
DATE:
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