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JUDITH T. TERRY • Town Hall, 53095 Main Road
TOWN CLERK ® P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS d® �� Fax (516) 765-1823
MARRIAGE OFFICER ' '`' �® Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER '_7®,l . 0
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. 3236-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner HONERKAMP, FRANK AND RUTH
Mailing Address 1 P. O. BOX 255
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 1690 MARLENE LANE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-5365
Tax Map No. section 144.00 block 2 lot 34.000
Cross Street ROUTE 25
Issue Date: 8/16/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK '00 COHU(
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Town of SoutholdCQG=� - Application No.5 a.3,6
Judith T. Terry, Town Clerk �` y
Town Hall, 53095 Main Road $10.00 Residential
P. O. Box 1179 crs `°' i " ' $25.00 - Non-Residential
Southold, New York 11971 O'�f,► O*J,
Telephone I V:1'�•
(516) 765-1801
•
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
• OPERATION PERMIT c'_
SEPTIC TANK or CESSPOOL r'p C3 a,0
Operation Permit No.
Fee $ v \
DATEI1AJ4 ^q-) 11)-
OWNER
-) 1OWNER NAME: paptl J Re`A., `I' /11 i2,4-YYI. e
OWNER MAILING ADDRESS: (9)/, (- (376".
44,/,
* rye Nil /
OWNER PROPERTY ADDRESS: J&e(O111A-MON-e„ d\--A pre
OWNER TELEPHONE NUMBER: v r' E5--G
TAX MAP NO. : Section Block Lot
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
•Cesspool ,/ New Existing V
Residential +' 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.)
( Pt
-A Of, ,, II
SignatureApplic
RECEIVED BY:
Town Clerk's Office ,
DATE: ail 144'4f
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