HomeMy WebLinkAboutWright, Richard SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4332-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner RICHARD & PATRICIA WRIGHT
Mailing Address 1 530 WOODCLIFF DR
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 SAME AS ABOVE
Property Address 2
City St Zip 00000-0000
Owner Telephone No. 631-298-7423
Tax Map No. section 107.00 block 8 lot 130
Cross Street BROWER RD
Issue Date: 2/22/07 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
ELIZABETH A.NEVILLE 0 �'L` , Town Hall, 53095 Main Road
TOWN CLERK ' ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS W Southold,New York 11971
MARRIAGE OFFICER \ y 'F �� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER - � i�� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER * �a�', southoldtown.northfork.net
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
OPERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @$10 X or Non-Residential @ $25 Application No.—1 .
Permit No.
Owner Name -.-- 1C-1-1/4/(._ A .I (7)-4 ��-12 I CIA UAL I(7)-(j
Owner Mailing Address 5 3o l.)00 a C 117
MArr- rvc�� , I q s z--
Owner Property Address _c (t
p
Owner Telephone No. l73( "��-� O -- z 3
Tax Map No: Section I D- 00 Block Lot 1 3 0C)
Cross Street v!
Please check each that applies: New Construction
Alteration to Existing tem
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 sury 'th SCHD approval.)
Z-I 2 Lts
ignature of Apant 1 o
Received byV.CC)•
COASTLINE CESSPOOL & DRAIN SERVICE
4225 Bridge Lane
,. Cutchogue,L.I.,N.Y. 11935
631-734-6585
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SCCA Lie. #168-LW NYS DEC #1A-600