HomeMy WebLinkAboutHildebrandt, Wayne ,00SUFFot,r
4419G
ELIZABETH A.NEVILLE ���_� * ; Town Hall, 53095 Main Road
TOWN CLERKH - P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS 0
MARRIAGE OFFICER Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER y'f101 .�`��l Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
'!...••iii
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4136-R Residential X Non-Residential
Fee $ 10.00 New Existing x
Name of Owner HILDEBRANDT, WAYNE
Mailing Address 1 2875 MAIN BAYVIEW ROAD
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 2875 MAIN BAYVIEW ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 631-765-5658
Tax Map No. section 780.00 block 100 lot 37.001
Cross Street GLENN ROAD
Issue Date: 4/02/02 Elizabeth A. Neville
Southold Town clerk
(TOWN SEAL)
•
.
OFFICE OWN OI!SOTUfHOLDNOWN CLERK CLERK &„CONo. I>//. 6
ELIZABETH A.NEVILLE,TOWN CLERK $10.00 - Residential
P.O.BOX 1179
SOUTHOLD,NEW YORK 11971 **$ $25.00 - Non-Residential
Telephone 4' 4 Ais
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
fcr
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ )0 .00
DATE
OWNER NAME: V\art. P-I&f�nd+
OWNER MAILING ADDRESS: 2:?-75 Mem 60011) iZd
(500+hb1d4 A /MI
OWNER PROPERTY ADDRESS: 2 315 Ailan Fj VIAL) r(cJ
&) hDLd I II II
OWNER TELEPHONE NUMBER: ( 1p31 ) 7C.PJ" 5.05
TAX MAP NO. : Section 1g,UO Block I Lot 5i, Do I
CROSS STREET: e`Q,nn ti d
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ✓ New . Existing add+DiI -JO
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.)
1)0 0.41tr-t-Signature o Applicant
RECEIVED BY: !16//6
T wn Clerk's Offic
DATE: ,5 o `�
/\,
it
r
- - _
.....,
- 1
p - _
r,J Eliv q
,1‘ ,.....,
(......) 0
I
o ca
[
[
, P
t15
Mn 6.21011,) 1
1 •-- .
1 ,
\.. ,
1
[ ,
[ ,
[
)
,