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JUDITH T. TERRY T . Town Hall, 53095 Main Road
o P.O. Box 1179
TOWN CLERK � fi
REGISTRAR OF VITAL STATISTICS .�`' Southold, New York 11971
MARRIAGE OFFICER i O ,!� Fax (516) 765-1823
6,70 �;��� Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3061-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner JAEHNE
Mailing Address 1 P. O. BOX 124
Mailing Address 2
City St Zip PECONIC NY 11958-0000
Property Address 1 300 SECOND AVNEUE
Property Address 2
City St Zip PECONIC NY 11958-0000
Owner Telephone No. 516-765-4163
Tax Map No. section 67.00 block 4 lot 23.000
Cross Street MILL LANE
Date Of Last Pump Out 0/00/00
Issue Date: 7/13/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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.- O FICE OF THE TOWN CLERK �cOMe-- '
Town of Southold ��� :;. COG Application
Judith T. Terry, Town Clerk . 4 :
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