HomeMy WebLinkAboutFiedler ztiketik
Town Hall, 53095 Main Road
‘1654,, ,_ � ��! P.O. Box 1179
Southold, New York 11971
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JUDITH T.TERRY � `Zsg 'i�' TELEPHONE
TOWN CLERK I (516) 765-1801
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. 760-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner FIEDLER, FREDERICK W.
Mailing Address 1 775 REYDON DRIVE
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 775 REYDON DRIVE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-5525
Tax Map No. section 79.00 block 5 lot 15. 001
Cross Street NORTH BAYVIEW ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 7/19/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK ��1 E0U(
Town of Southold , 1 • C'� i,, Application No. '7,
Judith T. Terry, Town Clerk �1 Residential
Town Hall, 53095 Main Road 8� , vf
P. O. Box 1179 ,a �
S11!/7'‘ Non-Residential
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Southold, New York 11971 O °t' ' �`�
Telephone Q(
(516) 765-1801
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TOWN OF SOUTHOLD •
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SOUTHOLD WASTEWATER—DI-SPOSikL DISTRICT
\APPLICATION
for `
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OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No
Fee $ /0,66
DATE 7//7 /0C)cep
OWNER NAME: i Fre-he-ed
OWNER MAILING ADDRESS: 7?1.--/ Rgv Li
; S044X0 /,-_,72V/
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: 36r—cc—S.-ZS
TAX MAP NO. : Section -7 9 Block S Lot /S.
CROSS STREET: )\) , 6/91/ )f'¢4i Rc,
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool x New Existing i
Residential )( Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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 Applicant
RECEIVED BY:
REGEII�P'
n CIedrk's Office
DATE: JUL 18 1988
town Clerk Southold
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