HomeMy WebLinkAboutReich (2)<i
JUDITH T. TERRY
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3009-R Residential X Non -Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner REICH, MICHAEL
------------------------------
Mailing Address 1 P. O. BOX 104
------------------------------
Mailing Address 2
------------------------------
City St Zip SOUTHOLD NY 11971-0000
-------------------'- -- ----------
Property Address 1 185 SUNSET WAY
------------------------------
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
-------------------- -- ----------
Owner Telephone No. 516-765-3220
------------
Tax Map No. section 91.00 block 1 lot 14.000
Cross Street CEDAR BEACH ROAD
------------------------------
Date Of Last Pump Out 0/00/00
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (516) 765-1823
Telephone (516) 765-1801
----------------------------------
Issue Date: 4/29/93 Judith T. Terry
-------- Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK
Town of Southold
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road
P. 0. Box 1179
Southold, New York 11971
Telephone
(516) 765-1801
TO1%1N OF SOUTHOLD
Application No.306'?
$10.00 - Residential (f
$25.00 - Non -Residential
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $10:,00
DATE
OWNER
j� TT
OWNER NAME:
OWNER MAILING ADDRESS: Q _ � zpCt� �aC�f
11q cz
OWNER -PROPERTY ADDRESS-: 57 9-�74"tt,-f?
OWNER TELEPHONE NUMBER:
TAX MAP NO.: Section Block Lot
CROSS STREET:
TYPE; QF, -,SYSTEM: Septic Tank - - --New Existing
Cesspool New Existing
Residential Non -Residential
DATE OF PREVIOUS PUNIP-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.)
- - e
Signature of Applicant
RECEIVED -BY:
Town Clerk's Office
DATE: � � - - - - -- -------: