HomeMy WebLinkAboutRuch 1
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I Town Hall, 53095 Main Road
� �� P.O. Box 1179
_® ®� w"/ Southold,Southold, New York 11971
JUDITH T.TERRY TELEPHONE
TOWN CLERK -�o<�,o�� /1, (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERIC
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 784-R Residential X Non-Residential
Fee $ 10. 00 Septic X Cesspool
New Existing X
Name Of Owner RUCH, ELEANOR L.
Mailing Address 1 54300 NORTH ROAD
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 54300 NORTH ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-2145
Tax Map No. section 52. 00 block 3 lot 1. 000
Cross Street 'RUCH LANE
Date Of Last Pump Out 0/00/00
Issue Date: 8/10/88 Judith T. Terry
Southold, Town Clerk
(TOWN SEAL)
•
• •..
OFFICE OF THE TOWN CLERK �•
Town of Southold 5�FF0 { 6
QG;. Application No.
Judith T. Terry, Town Clerk rt `~y
Town Hall, 53095 Main Road1 Residential L
P. O. Box 1179cn hzi •��
4 , rft:g. � Non-Residential
Southold, New York 11971 O le) � ��
Telephone 01 `��
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT •
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ 6'-'"
DATE / /c
atm 69 e
OWNER NAME: e� \r-\
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OWNER MAILING ADDRESS: (��,
r
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: y
TAX MAP NO. : Section Block 3 Lot
CROSS STREET: RtY(fl, e_ -4-- R4- g
TYPE OF SYSTEM: Septic Tank a New Existing
Cesspool J New Existing
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: yl.Q .z.l / 9,6
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.)
•
Signature of Applicant
RECEIVED BY:
ROgliVrOrn Clerk's Office
DATE: ALIG 0 1989
CIO* Sgalca .