HomeMy WebLinkAboutMunch Gt. INfte
Town Hall, 53095 Main Road
qrfb - $ P.O. Box 1179
0rSouthold, New York 11971
JUDITH T. RK
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(516) 765-1801
OWN CLE
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL,
Operation Permit No. 825-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner MUNCH, RICHARD W.
Mailing Address 1 MUNCH, MARGARET A.
Mailing Address 2 1895 MARYS ROAD
City St Zip MATTITUCK NY 11952-0000
Property Address 1 1895 MARYS ROAD
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-5879
Tax Map No. section 139.00 block 4 lot 2. 001
Cross Street OAK PLACE
Date Of Last Pump Out 0/00/00
Issue Date: 9/12/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK
Town of Southold -, Application No.
Judith T. Terry, Town Clerk , ,; '
• Town Hall, 53095 Main Road Residential
P. O. Box 1179 cr3 moi ; Non-Residential
▪ Southold, New York 11971 Ot: e�0 •1`�
Telephone ,( �
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
.or
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /0p01
DATE q`gl gg
OWNER NAME: flChrjrd \A[ and Nilarrre - P. Numb
OWNER MAILING ADDRESS: I'M M;),.rr,CA mad
OWNER PROPERTY ADDRESS: Sam Q.5 above
OWNER TELEPHONE NUMBER: (Vg--5S--19
TAX MAP NO. : Section /37 Block Lot c2, f r
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New • Existing
Cesspool t' 3 New Existing 17
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: ?' r4eNer
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:
Town Clerk's Office
DATE:
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