HomeMy WebLinkAboutNeumann f •+i
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.�', . E=4" Town Hall, 53095 Main Road
` ' P.O. Box 1179
®��®� Is1,3 Southold, New York 11971
JUDITH T.TERRY - r%� ` FAX(516)765-1823
TOWN CLERK TELEPHONE(516)765-1801
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. 1477-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner NEUMANN, ARLOA K.
Mailing Address 1 3175 NASSAU POINT ROAD
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 3175 NASSAU POINT ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-6339
Tax Map No. section 104.00 block 13 lot 12.000
Cross Street VANSTON ROAD
Date Of Last Pump Out 0/00100
Issue Date: 6/07190 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
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OFFICE OF THE TOWN CLERK c�VFFO(,(' y
Town of Southold A . C'O '- /Application No. 9
Judith T. Terry, Town Clerk . 444. �y«. $10.00 - Residential
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Town Hall, 53095 Main Road a , 'esti
P. 0. Box 117 9 F G'�` z
� ,�� z $25.00 - Non-Residential
Southold, New York 11971 O ® '-s= Off- *�$
Telephone l�Oj '�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
• 'for-
•
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE 511746.
OWNER NAME: �L Dq jl r 1fV ei Jnv1--i'2t1Y/Y •
OWNER MAILING ADDRESS: (7S /yt 5R p P' a d
Oc5±C,(n t)C5-0-€
.OWNER_PROPERTY__ADDRESS
:_.. �_ _�
• OWNER TELEPHONE NUMBER: 5-11-‘13 t4 —V”Cj
TAX MAP NO. : Section Block Lot
•
CROSS STREET:
TYPE OF SYSTEM: Septic Tank - -New Existing
Cesspool y/ New Existing I/
Residential v/ Non-Residential
DATE OF PREVIOUS PUMP-OUT: I q C1 Q
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.)
e4. OI itoiDe _as Fee. .E/45-1, kD/4_
Signature of Ap scant
RECEIVED BY:
Town Clerk's Office
DATE: _
JUN 0 7