HomeMy WebLinkAboutMeinke ?N_ -I �I,,
OFFOLit --
JUDITH T.TERRY x� � Town Hall, 53095 Main Road
TOWN CLERK 1 P.O. Box 1179
PPS Southold, New York 11971
REGISTRAR OF VITAL STATISTICS ® �� Fax(516) 765-1823
MARRIAGE OFFICER . ��
RECORDS MANAGEMENT OFFICER _ ®,� ��®���� Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER ��
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3662-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner MEINKE, HOWARD
Mailing Address 1 P. O. BOX 78
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 2130 BROADWATERS ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-6724
Tax Map No. section 104.00 block 9 lot 13.000
Cross Street HAYWATERS ROAD
Issue Date: 7/23/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK 'COMA'
Town of Southold �� e4-1-4\ Application No. (3
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road $10.00 - Residential
cn `,
P. O. Box 1179 � F�� r�`. �i ; $25.00 - Non-Residential
Southold, New York 11971 O
Telephone *.(o
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /D
DATE C.1 °' C
OWNER NAME: lajJ. /'15)A 'f:
OWNER MAILING ADDRESS: 9,0 )5b" IF
OWNER PROPERTY ADDRESS : 2,1 3 a b f41)t.
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OWNER TELEPHONE NUMBER: ' LJ. -9
- 13
TAX MAP NO. : Section Block - Lot
CROSS STREET: //// Lt)fi7 /2S Zip
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential 2c, 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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/ 1 Signat -o Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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