HomeMy WebLinkAboutRugen i *le
C=I ,' Town Hall, 53095 Main Road
/ P.O. Box 1179
4401 10.,•••• Southold, New York 11971
JUDITH T.TERRY 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. 1567-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner RUGEN, HENRY
Mailing Address 1 13920 SOUNDVIEW AVENUE
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 13920 SOUNDVIEW AVENUE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-5168
Tax Map No. section 54.00 block 3 lot 3.000
Cross Street HORTON LANE 8 LIGHTHOUSE ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 10/23/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
vr' , • ,.. • / 5c- 7
`OFFICE OF THE TOWN CLERK �giFFOL"�'-G-
-
Town or Southold Application No.
Judith T4 terry, Town Clerk :}
Town Hall, 53095 Main Road $10.00 - Residential
P. O. Box 1179 u-3 v ` $25$25.00 - Non-Residential
Southold, New York 11971J "IC $
Telephone ( '�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ (O
DATE ? // Igo
OWNER NAME: 14-e,
•
' / 1
OWNER MAILING ADDRESS: .7cDUhett# I C-il) ad 's^
,5'�h.10 �=>/o !01,2,
•
OWNER PROPERTY ADDRESS: 14yf _.,
OWNER TELEPHONE NUMBER: 7Gs.��;la F--
TAX
TAX MAP NO. : Section 54' Block Lot J"
CROSS STREET: �.� s ; ' 14% L;.
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool �' New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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.)
�' ur"e o/ pp scant
RECEIVED BY:
Town Clerk's Office
DATE:
OCT 22 acjj
Town CI®r;•; So4 GM