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Home My WebLink AboutBohach, William (2) , *., orif �• 01 Sout4, ELIZABETH A.NEVILLE ��,`� l� Town Hall,53095 Main Road TOWN CLERK 4 4, P.O. Box 1179 REGISTRAR OF VITAL STATISTICS va Southold, New York 11971 MARRIAGE OFFICER G �� Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER % ��I� Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER �COUNTY i southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 4354-R Residential X Non-Residential Fee $ 10.00 New Existing X Name Of Owner BOHACH, WILLIAM & CHRISTINE Mailing Address 1 7480 NORTH BAYVIEW ROAD Mailing Address 2 City St Zip SOUTHOLD NY 11971-0000 Property Address 1 SAME Property Address 2 City St Zip 00000-0000 Owner Telephone No. 631-265-8326 Tax Map No. section 79.00 block 7 lot 11.000 Cross Street TOPSAIL & JACOBS Issue Date: 8/21/07 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) Y 1 o%$UFFO(4►c ELIZABETH A.NEVILLE /0) �4\ Town Hall, 53095 Main Road TOWN CLERK P.O. Box 1179 at REGISTRAR OF VITAL STATISTICS y, Southold, New York 11971 MARRIAGE OFFICER : air t% Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER =_4 str of Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER �'� 4, 1/ 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 @$25Application No., ' Permit No 23 Owner Name (.t� i (/iP4 Yvt 4 Owner Mailing Address 7C b /V,12-Y Ef 4 yj9 ,) S a c e / °"'‘") V 1/t 77 Owner Property Address Owner Telephone No. 6 3 / Tax Map No: Section 7?- e!) Block -7 Lot 1 /09c) Cross Street '-7-e,P5c4,46 S Please check each that applies: New Construction Alteration to Exisystem 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.) 519/0 /95 C0N7- 4id4a. 7 „6,f<vt /7 Signature of Applicant Date Received by: