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JUDITH T. TERRY 14Town Hall, 53095 Main Road
TOWN CLERK ® r P.O. Box 1179
` i $ Southold, New York 11971
REGISTRAR OF VITAL STATISTICS V �% Fax (516) 765-1823
MARRIAGE OFFICER s�/� ®I•1� Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER �77®1 41 -0
FREEDOM OF INFORMATION OFFICER I
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3208-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner FRAUENBERG, HOWARD
Mailing Address 1 R.R. 2, BOX 60
Mailing Address 2
City St Zip HAWLEY PA 18428-0000
Property Address 1 555 LOCUST AVNEUE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 717-226-2644
Tax Map No. section 62.00 block 3 lot 33.000
Cross Street L'HOMMEDIEU LANE
Issue Date: 5/19/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
i
OFFICE OF THE TOWN CLERK c0FO(,1C;- .
Town of Southold �� ;Y Application No. '
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road $10.00 - Residential
P. O. Box 1179 � $25.00 - Non-Residential •
t•.Southold, New York 11971 Or' •�`
Telephone �.(r* y► '°
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
=_, Akr
-
for _ - - - •-
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ lU
DATE I "Pf
OWNER NAME:j 6 W Jr ie J) F J2 4 v i/'(/3 / ' D-
OWNER MAILING ADDRESS: • (� y 8 0 pt 4.
H I cv / 4i Pi - 7/ P
OWNER PROPERTY ADDRESS: ✓ ✓-- c ,
OWNER TELEPHONE NUMBER: 7 / 7 - Z h i •
TAX MAP NO. : Section 1— Block 3 Lot 3 3
CROSS STREET: if
TYPE OF SYSTEM: -Septic Tank- -_.- New Existing
Cesspool 7� New Existing
Residential 1 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 'e of Applicant
RECEIVED BY:
r = Town .CIe k's Office
DATE:_(j�.
•
L4/tx- •`4,90z-44ge� 5 5 5 L o c h 51 L A .
- Sec. G2 &ccK $ 2dT 33
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