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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK ® rri .' P.O. Box 1179
aC ,� Southold, New York 11971
REGISTRAR OF VITAL STATISTICS �® �. �% Fax (516) 765-1823
MARRIAGE OFFICER '_ '` Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER 7®,l it
FREEDOM OF INFORMATION OFFICER
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3218-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner RICHTER, CRAIG
Mailing Address 1 P.O. BOX 676
Mailing Address 2
City St Zip GREENPORT NY 11944-0000
Property Address 1 415 MCCANN LANE
Property Address 2
City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 516-477-1255
Tax Map No. section 33.00 block 3 lot 3.000
Cross Street COUNTY ROAD 48
Issue Date: 6/23/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFI`EE OF THE TOWN CLERK cvFFIZir
Town of Southold OHO _ VCQG; Application No.,-34:
Judith T. Terry, Town Clerk •
Town Hall, 53095 Main Road .0 $10.00 - Residential ✓
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P. 0. Box 1179 cn . �' j' ' • $25.00 - Non-Residential
Southold, New York 11971O �.(®„
:�Telephone : Y+
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
OPERAT ION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ l�J
DATE J v NG. ac9j 16M1
OWNER NAME: � W1� �Or lekr-
OWNER MAILING ADDRESS: P. o , Box_ [76,
Greewpov "1 J .`1'. 11qvL
OWNER PROPERTY- ADDRESS: -I-1. 1 b Nike-CA-Iv
&tee•gwJ�ca r l $�� .�. � 1ct`�
OWNER TELEPHONE NUMBER: S 1 L e y
TAX MAP NO. : Section j 011)-33 Block Lot 03
CROSS STREET: c:) r4-717- Z.).f}c 4 CI
TYPE OF SYSTEM: Septic Tank V" New Existing
Cesspool ‘/ New Existing
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.)
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Sig -tu" of A.plican
RECEIVED BY:
Town Clerk's Office
DATE:
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