HomeMy WebLinkAboutRehwinkelo\®c�VF►�®L��„®G
Ln Town Hall, 53095 Main Road
P.O. Box 1179
®1 �® Southold, New York 11971
JUDITH T. TERRY TELEPHONE
TOWN CLERK (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. 1098-R Residential X Non -Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner REHWINKEL, CHARLES H. 8 ANO
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Mailing Address 1 1450 GLENN ROAD
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Mailing Address 2
City St Zip
Property Address 1
Property Address 2
City St Zip
Owner Telephone No.
Tax Map No. section
Cross Street
Date Of Last Pump Out
Issue Date: 5/08/89
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SOUTHOLD NY 11971-0000
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1450 GLENN ROAD
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SOUTHOLD NY 11971-0000
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516-765-2031
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78.00 block 2 lot 32.000
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SHEPARD DRIVE
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4/00/86
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Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK
Tcwn of Southold O�Q �QG Application No.
Judith T. Terry, Town Clerk � _
Town Hall, 53095 Main Road -� I Residential
P. 0. Box 1179 v' Non -Residential
Southold, New York 11971 O
Telephone
0,( �►���
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
1
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ �o
DATE'
0 W N E R N AME: C/�,c°[ G ej' i7 �E'y`1rl�lii/ �" �. b� �A
OWNER MAILING ADDRESS: /44�0_® (�?i,-'A/oJ
A/, ' // �%/
OWNER PROPERTY ADDRESS: /L�C,�'o .Gc w�� A)
e
JovAl,'y 141175
OWNER TELEPHONE NUMBER: ___r4 "- ®,;5O
TAX MAP NO.: Section 7,0' Block Z Lot
CROSS STREET: Zec"Pw b ..Jed
TYPE OF SYSTEM: Septic Tank New i Existing v
Cesspool New /974 Existing v
Residential , Non -Residential
DATE OF PREVIOUS PUMP -but; �/ / " �!o
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 ;sand closest road.)
Signattrfre of Applicant
RECEIVED BY:
RECW&wn Clerk's Office
DATE: MAY QR 1999
Tom Clll!ds soi>m
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