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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK ® rn P.O. Box 1179
REGISTRAR OF VITAL STATISTICS U' .` Southold, New York 11971
y r Fax (516) 765-1823
MARRIAGE 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. 3187-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner SEIDMAN, NATHAN B.
Mailing Address 1 343 9TH AVENUE
Mailing Address 2
City St Zip NEW YORK NY 10003-0000
Property Address 1 29215 MAIN ROAD
Property Address 2
City St Zip ORIENT NY 11957-0000
Owner Telephone No. 000-000-0000
Tax Map No. section 13.00 block 2 lot 9.000
Cross Street HEATH DRIVE
Issue Date: 3/18/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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