HomeMy WebLinkAboutRempe 11'0 s,„,” ���®e��®
JUDITH T.TERRY 1 r` f �• Town Hall, 53095 Main Road
TOWN CLERK cog, P.O. Box 1179
Iva 1 Southold,New York 11971
REGISTRAR OF VITAL STATISTICS ® � Fax(516) 765-1823
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MARRIAGE OFFICER �= j� ��®�i�� Telephone(516) 765-1800
RECORDS MANAGEMENT OFFICER �•�
FREEDOM OF INFORMATION OFFICER —••.., .����
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3732-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner REMPE, THOMAS -
Mailing Address 1 P. O. BOX 701
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 575 EASTWARD COURT
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-8523
Tax Map No. section 115.00 block 7 lot 8.000
Cross Street ROUTE 25
Issue Date: 11/24/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
a' •• •..ii
OFFICE OF THE TOWN CLERK
Town of Southold *0, 0�0� =\ Application No.. 2
Judith T. Terty, Town Clerk . "
$10.00 - Residential
• Town Hall., 53095 Main Road
P. Cf' Box 1179 tri ;� ; ' $25.00 - Non-Residential
Southold, -New York 11971 4 *-$
Telephone
Telephone _ .(
•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE ///e--1
OWNER NAME: --"V(1,0 rYLQ,S
OWNER MAILING ADDRESS: (---ec' 'IJO, /76 I
1. a _
OWNER PROPERTY ADDRESS: 5 `S as .
p\o, �, 1 -1195
OWNER TELEPHONE NUMBER: 5/1„, - 6,9F- 86Q3
TAX MAP NO. : Section I i S Block -7 Lot 67
CROSS STREET 0(, - 3
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential 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.)
.�.
/- 4A
Signature of i.plicant
RECEIVED BY:
/Tow". —lerk's Office
DATE: /( l ci?
/
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