HomeMy WebLinkAboutReyer ®sofF®L��
ELIZABETH A.NEVIL.LE �$' ,. ®4 ; Town Hall, 53095 Main Road
TOWN CLERK • i ® P.O. Box 1179
PA 141 Southold,New York 11971
REGISTRAR OF VITAL STATISTICS avv'�� Fax(516) 765-1823
MARRIAGE OFFICER V 44'1'. Telephone(516) 765-1800
RECORDS MANAGEMENT OFFICER �®i ,�22,, �• 0
FREEDOM OF INFORMATION OFFICER - - `L s ����
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3754-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner REYER, ROBERT
Mailing Address 1 1735 WESTPHALIA ROAD
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 1735 WESTPHALIA ROAD
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-4691
Tax Map No. section 141 .00 block 1 lot 5.000
Cross Street COUNTY ROUTE 48
Issue Date: 1/22/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
Iii
OFFICE OF THE TOWN CLERK ' ��FO
Town of Southold , ���� CQG';, Application NoJ 7S
Judith T. Terry, Town Clerk �1
Town Hall, 53095 Main Road $10.00 - Residential
P. O. Box 1179 cra $25.00 - Non-Residential
Southold, New York 11971 O ��$
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Telephone d * ,.Y►
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
•
DATE /----c ?-9g
OWNER NAME: 6Ojf / Fye-Jo
OWNER MAILING ADDRESS: ,73 (J�•' 57-02sy¢JZ.i a Alp/1%i7r11-dcA IV)' /1,:q-
OWNER PROPERTY ADDRESS: 5/9//
OWNER TELEPHONE NUMBER: o/' ` c/8 7'6 9/
TAX MAP NO. : Section 0q Block / Lot 5 •
CROSS STREET: CT/ , lam', 2f
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ✓ New Existing ,
Residential t/ 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.)
Signature�f Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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