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ELIZABETH A.NEVILLE I�� ,®`yam; Town Hall, 53095 Main Road
TOWN CLERK e P.O. Box 1179
2 Southold,New York 11971
REGISTRAR OF VITAL STATISTICSIrPV
Fax(516) 765-1823
MARRIAGE OFFICER y � �eV '� Telephone(516) 765-1800
RECORDS MANAGEMENT OFFICER ® m • •
FREEDOM OF INFORMATION OFFICER ���
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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. 3772-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner STEINBUCH, DAVID L.
Mailing Address 1 P. O. BOX 1324
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 18385 SOUNDVIEW AVENUE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-3501
Tax Map No. section 51 .00 block 1 lot 11 .000
Cross Street MT. BEULAH
Issue Date: 3/05/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
OFFICOF THE TOWN CLERK .
tC$FOL4
TOWN OF SOUTHOLD 0�� Application No. 7 7�
ELIZABETH A.NEVILLE,TOWN CLERK $10.00 - Residential
P.O.BOX 1179
4 kL M $25.00 - Non-Residential
SOUTHOLD,NEW YORK 11971 ^ t
Telephone
1,90/11,_"— goes
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
•
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /®
DATE .._.V(/47,
/47,
OWNER NAME: t__470,-/P 1- J frisuc'/
OWNER MAILING ADDRESS: /0- elwe
OWNER PROPERTY ADDRESS: 1S/ 38- mSa c/ ,e-t✓ / -
,,/777) G, ( 1Y / (97 /OWNER TELEPHONE NUMBER: 070) 7C-j" 3S D )
TAX MAP NO. : Section 37-7 Block Lot l
CROSS STREET: /f% &.(A4-174-
TYPE
.(/4 74TYPE 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.)
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