HomeMy WebLinkAboutSichler S.,
JUDITH T. TERRY : Town Hall, 53095 Main Road
• TOWN CLERK O *am P.O.P.O. BOX 1179
REGISTRAR OF VITAL STATISTICS � Southold, New York 11971
MARRIAGE OFFICER =yQ ®� ��, Fax (516) 765 1823
'yol �1a �� Telephone (516) 765-1801
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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. 3071-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner SICHLER, ROY AND MARIANNE
Mailing Address 1 200 BREITSTADT COURT
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 200 BREITSTADT COURT
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-6176
Tax Map No. section 70.00 block 9 lot 28.000
Cross Street CLEARVIEW AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 7/27/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK cSFO(,('
Town of Southold �CQG', Application No.�O`�
Judith T. Terry, Town Clerk n •'I v
Town Hall, 53095 Main Road $10.00 - Residential
P. O. Box 1179 u) 7 . '€ tri �` $25.00 - Non-Residential
Southold, New York 11971 O 0 '' ��'
Telephone
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICTRECEIVED
APPLICATION JUL 1993
for Southold Town Clerk
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE 7/cJoIg3
OWNER NAME: CO(.{ d- A-Lt ( tJC' S i,L
OWNER MAILING ADDRESS:
OWNER PROPERTY ADDRESS: a-00 �1 2.L l-`- j -j - G)-•
,Sou-ir 1rt01 &L---
OWNER TELEPHONE NUMBER: (576,) 7t'
TAX MAP NO. : Section 704 Block ` �' Lot - *s a
CROSS STREET: C (J /7i. ( / L) AU
TYPE OF SYSTEM: Septic Tank V New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: r_
11 / 9 R 3
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.)
unn
Signatuftrof Applicant
RECEIVED BY:
Town Jerk's Office
DATE: � ' a ' 93
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