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JUDITH T. TERRY Town Hall, 53095 Main Road •
TOWN CLERK -
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P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ir' Southold, New York 11971
MARRIAGE OFFICER � Q` O� ��, Fax (516) 765-1823
Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 2057-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner STEINBUGLER, ANNE
Mailing Address 1 173 HICKS STREET, APT. 6C
Mailing Address 2
City St Zip BROOKLYN NY 11201-0000
Property Address 1 14505 MAIN BAYV I EW ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 718-596-4157
Tax Map No. section 89.00 block 1 lot 5.000
Cross Street CEDAR BEACH ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 2/24/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK se cOFN
Town of Southold CQ ' Application No. 00,5-7
-
Judith T. Terry,
Town Clerk . i►
Town Hall, 53095 Main Road ,;., .•c $10.00 - Residential
p. O. Box 1179crl . $25.00 - Non-Residential
Southold, New York 11971 O ® '_ '` ••`,
Telephone _0l44
1
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ b ; p�,
DATE 2/17/93
OWNER NAME: Anne Steinbugler
OWNER MAILING ADDRESS: 173 Hicks Street, Apt. 6C
Brooklyn, NY 11201
-OWN E RPROPERTY ADDRESS: I urger ° 1ca,- i o;,7a7 ocuh __,
Southold, NY 11971
S
OWNER TELEPHONE NUMBER: 718-A96-4157 Office: 212-553-0368
Plots numbered one (1) , two (2) andone hundred fifty-seven (157)
TAX MAP NO. : Section I ob -- o$1 Block 0 -Lot 1-f a`
on a certain map entitled"Subdivision neap of Cedar Beach Park, situate
CROSS STREET: at Bayview in the Town of Southold"
Cross--Street: Main:,.Bayview_-Road
TYP-E=OF =SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: October 7 , 1992
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 Appli ant
Anne Steinbugl r
-
'1-11."1
RECEIVED BY -- _
Town Clerk's Office
DATE:
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