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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: -