HomeMy WebLinkAboutFriedman JUDITH T.TERRY ® �s,x fif rE . Town Hall, 53095 Main Road
%TOWN CLERK ; P.O.Box 1179
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REGISTRAR OF VITAL STATISTICS ;x° Southold,New York 11971
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MARRIAGE OFFICER ‘1242
(4SP / Fax(516)765-1823
RECORDS MANAGEMENT OFFICER ®4 4*„/� 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. 3413-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner FRIEDMAN, JOSEPH AND ELEANORE
Mailing Address 1 590 RILEY AVENUE
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 590 RILEY AVENUE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-0164
Tax Map No. section 1113.00 block 5 lot
Cross Street BRAY AVENUE
Issue Date: 11/24/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK 'G��FU `i '=
Town of Southold &VC&, Application No. 3 l 2j
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road . $10.00 - Residential
P. O. Box 1179 cry - $25.00 - Non-Residential
Southold, New York 11971 �0*.$
0
Telephone 1 411
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. -
Fee $ 'd
i
DATE 11/06e
OWNER NAME: j6S6-P4 ¢` ei.6-Ong2ff 2/O'Dm0
OWNER MAILING ADDRESS: c/'J6 /2/-ef g16
!/1�Arrl�-�sLl� $ 111 re
OWNER PROPERTY ADDRESS: 09-016--
OWNER TELEPHONE NUMBER: �/e 4 (/
TAX MAP NO. : Section /L13 Block 0 \-- Lot )L
CROSS STREET: &Pi
TYPE QtF' SYSTEM: Septic Tank New Existing (/ _
Cesspool New Existing
Residential (/ Non-Residential
LOCATION MAP: Must be attached hereto before e� mit' may be issued.
(Locate building and system; gl/ve north arrow and feet
of distance, approximately, to bui ding and closest road.)
Signature of Applicant
REat IVED'.BY.
Town Clerk's Office
DATE:
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