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HomeMy WebLinkAboutRuckel ;I . JUDITH T. TERRY % Town Hall, 53095 Main Road TOWN CLERK > ® rz P.O. Box 1179 Southold, New York 11971 REGISTRAR OF VITAL STATISTICS ‘20.4. ,' Fax (516) 765-1823 MARRIAGE OFFICER a® �� Telephone (516) 765-1801 RECORDS MANAGEMENT OFFICER = ®1 4 1� r�" � FREEDOM OF INFORMATION OFFICERir�; OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 3259-R Residential X Non-Residential Fee $ 10.00 New Existing X Name Of Owner RUCKEL, FRANK Mailing Address 1 P. O. BOX 652 Mailing Address 2 City St Zip NEW SUFFOLK NY 11956-0000 Property Address 1 1000 FANNING ROAD Property Address 2 City St Zip NEW SUFFOLK NY 11956-0000 Owner Telephone No. 516-734-5517 Tax Map No. section 117.00 block 6 lot 311.000 Cross Street NEW SUFFOLK ROAD Issue Date: 10/18/94 Judith T. Terry Southold Town Clerk (TOWN SEAL) I. L1 OFFICE OF THE TOWN CLERK 'SWFfJIi - Town of SoutholdCQA -` Application No. oZ5 Judith T. Terry, Town Clerk Town Hall, 53095 Main Road1 $10.00 - Residential 4 P. O. Box 1179 k„ 4" `' i ;' $25.00 - Non-Residential Southold, New York 11971 Off` O` � ��` Telephone �1 `" '0 (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ • DATE Oc_77/ /9 727` OWNER NAME: ie /t/./C- OWNER MAILING ADDRESS: /,0. 430X Z, OWNER PROPERTY ADDRESS:/O©© /t,(ill/V6 /? OWNER TELEPHONE NUMBER: 737 J-Z-17 TAX MAP NO. : Section / 1 7 Block % Lot 3 Liz- CROSS STREET: TYPE OF SYSTEM: Septic Tank 7 New Existing Cesspool / New Existing Residential V 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.) Signature of Applicant RECEIVED BY: '' own lerk's Office DATE: ./d/1/ / / 371 H u .s' iI ® E