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HomeMy WebLinkAboutNeumann f •+i 1. .�', . 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) • � . „ 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 y 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