HomeMy WebLinkAboutGatz (2) "417 air
i Town Hall, 53095 Main Road
P.O. Box 1179
4I')�1� ®� ,ss�� 1%U�� Southold, New York 11971
JUDITH T.TERRYs � TELEPHONE
�'1.1.1
TOWN CLERK (516)765-1801
REGISTRAR Oh VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3563-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner GATZ, WALTER AND MARILYN
Mailing Address 1 BOX 45
Mailing Address 2
City St Zip MATTTIUCK NY 11952-0000
Property Address 1 1800 SOUND AVENUE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-8877
Tax Map No. section 120.00 block 3 lot 7.000
Cross Street ALDRICH LANE
Issue Date: 12/18/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
;OFFICE OF THE TOWN CLERK IR
Town of Southold ��� C�� Application No. 3,5Z3
Judith T. Terry, Town Clerk x
Town Hall, 53095 Main Road i �; : ! $10.00 - Residential
P. O. Box 1179 �to '�" ,r. `-;�;•„� �,,„ i � $25.00 - Non-Residential
Southold, New York 11971 ‘t",'
'° � �`
Telephone _
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE /a -
OWNER NAME: (,0041 oil /%411e lY 6 /2-
OWNER
/2-
OWNER MAILING ADDRESS: f poo sound r 10m• 7 ,8®x 4
Tvc , /Veto / k/ // 5c
OWNER PROPERTY ADDRESS: 1900 SOUI)(1 'Rue, .
//A—T, TucE1 tv. 1• I(c?5
OWNER TELEPHONE NUMBER: .376 0 g T
TAX MAP NO. : Section
/ Block Lot
CROSS STREET: ,9/Jt/C/J 1_0/)l_
TYPE OF SYSTEM: Septic Tank - - - - New Existing
Cesspool New Existing X
Residential 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.)
/ Ada
•
ignature f Appli ant 4111
RECEIVED BY: -
Town Clerk's Office
DATE: -