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Town Hall, 53095 Main Road
P.O. Box 1179
rvA )Nti- di!� Southold, New York 11971
JUDITH T.TERRY =_ ` �11f 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. 1407-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner RIESE, ARLINE
Mailing Address 1 152 CAPTAIN KIDD DRIVE
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 152 CAPTAIN KIDD DRIVE
Property Address 2
City St Zip SOUTHOLD NY 11952-0000
Owner Telephone No. 516-298-4960
Tax Map No. section 106.00 block 2 lot 44.000
Cross Street ZENA ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 3/09/90 Judith T. Terr
Southold Town Clerk
(TOWN SEAL)
•
OFFICE OF-THE TOWN CLERK i OFOGr -
Town of Southold Q L' = /46)17
OG � Application No.
Judith T. Terry, Town Clerki1 .�
Town Hall, 53095 Main Road ,... $10.00 - Residential
�l i , r r+ rt
P. O. Box 1179 , $25.00 - Non-Residential
Southold, New York 11971 Obi {. � •
Telephone _ 1 4
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE 3/ 2/96
OWNER NAME: A R L o (NI ;•
S
OWNER MAILING ADDRESS: / 5 A �ea �-,ql�{ . '�, D-1) ThRuv
M AT7 r7 U (A. 'N.Y. 1195
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: p.,9 -g-1-1 96;0
TAX MAP NO. : Section / 6 Block Lot lig'
CROSS STREET: Z f'- NA C\O Ah
TYPE OF SYSTEM: Septic Tank r New Existing a
Cesspool New / Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: 2�-�J--
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.)
( )1/4-:kci°
Signatur of Applicant
RECEIVED BY:
Town Clerk's Office -
DATE: 3 -9 -9d - -
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