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JUDITH T. TERRY . : Town Hall, 53095 Main Road
TOWN CLERK ® T P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ill �` Southold, New York 11971
MARRIAGE OFFICER O
V� •� Fax (516) 765-1823
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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. 2050-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New X Existing
Name Of Owner PRESSLER, RICHARD & THERESA
Mailing Address 1 53987 MAIN ROAD -
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 510 TUTH I LL ROAD EXT.
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-2942
Tax Map No. section 55.00 block 6 lot 15.023
Cross Street ORIOLE DRIVE
Date Of Last Pump Out 0/00/00
Issue Date: 2/22/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFrICF OF THE TOWN CLERK •S�FFOur°°=
Town of Southold ,. CQG• Application No905-6
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road -•x' 7 $10.00 - Residential
P. O. Box 1179 v' x r `
� $25.00 - Non-Residential
Southold, New York 11971 O ;NA; _••
Telephone -.2Q1 ,
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
G
DATE [ 3
•
OWNER NAME: jC 'la.,rd Theesa_ Zeic—
OWNER MAILING ADDRESS: 5.39 g9 474-)N �D
--0Z.4) Aly ,197/
OWNER I ROPERT 1( ADDRESS: 572 To 6 h i LC ed �r
V1--1-Q Li V i 1 q 71
OWNER TELEPHONE NUMBER: 74p-..S
TAX MAP NO. : Section 5: 00 Block � Lot / 0 Z
CROSS STREET: Crco Le_ D�_^
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TYPE OF SYSTEM: Septic Tank 1New Existing
Cesspool )C 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.)
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Signature of Applicant
RECEIVED BY: � • (1)
own Clerk's Office
DATE: C1 t .
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