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Home My WebLink AboutGatz, Walter (2) off stIfF04,:\ ELIZABETH A.NEVILLE itGyA; Town Hall,53095 Main Road TOWN CLERK o P.O.Box 1179 REGISTRAR OF VITAL STATISTICS ‘‘14: � i Southold,New York 11971 1. MARRIAGE OFFICER ��A ��, Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER '; 4a01r.''.i� Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 4262-R Residential X Non-Residential Fee $ 10.00 New X Existing Name Of Owner GATZ, WALTER & MARILYN Mailing Address 1 PO BOX 45 Mailing Address 2 City St Zip MATTITUCK NY 11952-0000 Property Address 1 6568 SOUND AVENUE Property Address 2 City St Zip MATTITUCK NY 11952-0000 owner Telephone No. 631-298-8769 Tax Map No. section 113.00 block 7 lot 22.000 Cross Street COX NECK ROAD Issue Date: 9/13/04 Elizabeth A. Neville southold Town Clerk (TOWN SEAL) ELIZABETH A.NEVILLEOk%, Town Hall,53095 Main Road TOWN CLERK P.O.Boz 1179 REGISTRAR OF VITAL STATI8TICS Southold,New York 11971 MARRIAGE OFFICER �� F�� Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER �i Telephone(631) 765-1800 a P FREEDOM OF INFORMATION OFFICER =_�'� * ,,a" southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION OPERATION PERMIT CESSPOOL or SEPTIC TANK Residential @$10 ✓ or Non-Residential @$25 Application No.'/24 Z Permit No..,�/8 R Owner Name Zifai*- 17a/VrN (9Q7 z Owner Mailing Address p O . &0 X /\)ereibc,t, N.y- 1/( 5 , Owner Property Address C5%? SOW') d / a77'2 tuc% /i.y. 11‘16-. ) C-3/Owner Telephone No. f 2 9[ S'26 9 Tax Map No: Section //3 Block 07 Lot 2 2, Cross Street CD}( NecK Ed. Please check each that applies: New Construction X Alteration to Existing System Residential Non-Residential NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. (Locate building and system; give north arrow and approximate distance in feet from system to building and closest road. New construction may submit copy of survey with SCHD approval.) f , Y p.OT Sign ture of Applicant Date Received by: