HomeMy WebLinkAboutFenkl k " r Town Hall, 53095 Main Road
4P.O. Box 1179' Southold, New York 11971
JUDITH T.TERRY FAX(516)765-1823
TELEPHONE(516)765-1801
TOWN CLERK
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1329-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New X Existing
Name Of Owner FENKL, JEANNE
Mailing Address 1 22 GRAND AVENUE
Mailing Address 2
City St Zip PORT JEFFERSON STA. NY 11776-0000
Property Address 1 1475 PT. PLEASANT ROAD
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-474-5922
Tax Map No. section 1 .14 block 1 lot 551
Cross Street WESTPHALIA ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 12/01/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
( 4 • ...
OFFICE-OF THE TOWN CLERK c3IFO(,i�
Town of Southold � _ CQ Application No. /5c9-"c
Judith T. Terry, Town Clerk /..s4).47
Town Hall, 53095 Main Road qf; $10.00 - Residential
P. O. Box 1179 cry $25.00 - Non-Residential
Southold, New York 11971 top. ,42i-s41..,-171 .e.
Telephone ( `�0�P
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 56X)
Fee $ /0, 00
ak. l�9/ DATE //1/5/gr1
OWNER NAME: FL All< •
OWNER MAILING ADDRESS: .91g, C-A(q'7�)
P� T 1T S_i )' Ny l/ 776
O-WNER._PROPERTY ADDRESS -- _ L 7c Pry PL 674-S./tJ% 40 AI)
MA-—n C K 1 N'� (c E
rk
OWNER TELEPHONE NUMBER: serf.) CNwi-r'-) 06'16_q5gCF'
e TAX MAP NO. : Section I 1 T 00 Block I. Lot 5.0o I
CROSS STREET: W ESTE j4 L I f}- 12 O /-- b
TYPE OF SYSTEM: Septic TankNew ✓ Existing
Cesspool New L/ Existing
Residential / Non-Residential
DATE OF PREVIOUS PUMP-OUT: W/4--
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.)
Signature of pplicant
RECEIVED BY: r
Own Clerk's Office
DATE: I
4 r a
I
H-C (k_S �
clo
\J
M � `01 K e