HomeMy WebLinkAboutMandel (2) •,O\og�FFO(,(�eoG
JUDITH T.TERRY ���� yet Town Hall, 53095 Main Road
TOWN CLERK ; y Z P.O. Box 1179
r � Southold,New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER if� 0.o1� Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER ! * `1►a��� Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER .�.��,,.••�
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3496-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner MANDEL, HERBERT R.
Mailing Address 1 BOX 2130
Mailing Address 2
City St Zip CREENPORT NY 11944-0000
Property Address 1 1000 INLET LANE
Property Address 2
City St Zip CREENPORT NY 11944-0000
Owner Telephone No. 516-477-2223
Tax Map No. section 36.00 block 2 lot 26.001
Cross Street MAHANSSET AVENUE
Issue Date: 8/16/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
i,
- OFF S 'O-F THE TOWN CLERKPFFD
Tbwn of Southold , ,&N) �c '�\ Application No. 3"
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road a 1$ 10.00 - Residential
P. O. Box 1179 v' ,i �`' $25.00 - Non-Residential
Southold, New York 11971 O ' . . ,
�
Telephone --'10ik $� .
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE 16
1 ; y
OWNER NAME: /6,+ _ 44 c,1,,.4 Q i e /
OWNER MAILING ADDRESS: 4 "km, R, ,B 94 `J'J' O .r clV fl ,J /6'
I/9-4
OWNER PROPERTY ADDRESS: -6o0--k_Cof L P a- .e.r.,f,,e iiiii-w
OWNER TELEPHONE NUMBER: (lG , , 4,7T--)....2,22
TAX MAP NO. : Section 34 Block E Lot A6 , 9
CROSS STREET: //4 `‘. tt ci_e.,(2-- Ale
TYPE OF SYSTEM: Septic Tank V New Existing V'
Cesspool New Existing
Residential I// 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.)
/ ,, . ,
Signatu -` of p licant
RECEIVED BY: .
Town Clerk's Office •
DATE:
07,
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