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JUDITH T. TERRY �� O . Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS • v r� lSouthold, New York 11971
MARRIAGE OFFICER '�� Fax (516) 765-1823
®��a 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. 1666-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner SINRAMM, OTTO AND JOAN
Mailing Address 1 1330 CLEARVIEW AVENUE
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 1330 CLEARVIEW AVENUE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-6004
Tax Map No. section 70.00 block 9 lot 55.000
Cross Street MAILLER COURT
Date Of Last Pump Out 0/00/00
Issue Date: 4/16/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
r ,
OFFICE OF THE TOWN CLERK 'c- FUIk-=
Town of Southold C'� Application No.
Terry, Town Clerk Off. z}', G
Judith T. • ,, ,?;1 _ _ -
Town Hall, 53095 Main Road a$1 „ :'� $10.00Residential
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P. O. Box 1179 u-� '?'.,:%,MM hi ; $25.00 - Non-Residential
Southold, New York 11971 Ogit; sst`;-' I �`�
Telephone _ 1 %,"
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. / 6 -
Fee $
oy
,L
DATE / /6, ��
OWNER NAME :
OWNER MAILING ADDRESS: /330 c/��'/e'�/l
Sp d � A/• y //9 7 /-
OWNER rrcur-tRT s ADDRESS: - . -/ I -
OWNER TELEPHONE,.NUMBER: /� 76�® �a oO
TAX MAP NO. : Section Block 9' Lot
CROSS STREET: /72,9/C C. EC CT.
TYPE OF SYSTEM: Septic Tank } / New Existing
3 Cesspool New Existing
Residential Non-Residential
Tip//S
DATE OF PUMP-OUT: /OA/ /7'91
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 of Applicant
RECEIVED BY: Air , /
-own erk'- Office
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