HomeMy WebLinkAboutFreyherr C
;�, Town Hall, 53095 Main Road
`' P.O. Box 1179
Y_. ® s� ��of� Southold, New York 11971
JUDITH T.TERRY yi< FAX(516)765-1823
TOWN CLERK TELEPHONE(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. 1170-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner FREYHERR, RICHARD
Mailing Address 1 530 COLUMBUS AVENUE
Mailing Address 2
City St Zip EAST PATCHOGUE NY 11772-0000
Property Address 1 THIRD STREET
Property Address 2
City St Zip NEW SUFFOLK NY 11956-0000
Owner Telephone No. 516-286-0348
Tax Map No. section 117.00 block 7 lot 10.000
Cross Street ORCHARD AND KING STREETS
Date Of Last Pump Out 0/00/00
Issue Date: 6/26/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK 0FJ - '
Town of Southold � �QG', Application No. /17D
Judith T. Terry, Town ClerkJ .
Town Hall 53095 Main Road 0 4-r,f - Residential
P. O. Box 1179 u��'";, ,,,:} zNon-Residential
Southold, New York 11971 O � ' : 0���
Telephone : .� V
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /( •
DATE C /2-2/F-Y
OWNER NAME: Ri COG ree,wigefi
OWNER MAILING ADDRESS: SP3 ® CO Lev►'16 J., s A-0-e
1f-TC J1E N,/ /1772
OWNER PROPERTY ADDRESS: / 1/1eD 57pe.87-
ivE-to p o Li ivy
OWNER TELEPHONE NUMBER: ®241-6 r
TAX MAP NO. : Section //'7 Block 7 Lot k)
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
} Residential g 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.)
Signa ure •f icant
RECEIVED BY:
Town Cle
DATE: p, 12 i�' n
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