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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK f�+ P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER ti N°0 '�� Fax (516) 765-1823
��® ��I � 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. 1955-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner MEINHART, FRED J. AND WIFE
Mailing Address 1 115 EAST SIDE AVENUE
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 115 EAST SIDE AVENUE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-9482
Tax Map No. section 99.00 block 3 lot 19.000
Cross Street HARBORVIEW AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 8/14/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
.
*OFFICE OF THE TOWN CLERK •3��FO
Town of Southold ��� r CQG', Application No.7 IS
Judith T. Terry, Town Clerk �� `' "
.61 $10.00 - Residential I
Town Hall, 53095 Main Road
P. O. Box 1179 crl tAigi ' $25.00 - Non-Residential
Southold, New York 11971
Telephone = 1
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ 10 2.2-
DATE 1/43/ I g
OWNER NAME: SMCNR REtD �� S4 \ 1 E.
3
OWNER MAILING ADDRESS: 1 ) S Ef 1 SIDE.. P\v\
aM rL\—r'� )T'V 1N1 Y 11 9 52-
OWNER
2.OWNER PROPERTY ADDRESS: ,tA (Y\ OSE
OWNER TELEPHONE NUMBER: (..S1 G.) 29'2 pe ()I-1-S 2
TAX MAP NO. : Section Block .3 - Lot 1 q
CROSS STREET: 1�fW..EQR\,1 1 U\) fA\l E
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool / New Existing
Residential V Non-Residential
DATE OF PREVIOUS PUMP-OUT: ? ) I 9 2
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.)
gnat e of Applicant
RECEIVED-_ BY: Rietwkt - - -
erk's Office
DATE: AUC 'Poo
Town Clerk Southold
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