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Town Hall, 53095 Main Road
P.O. Box 1179
, T '4. Southold, New York 11971
7UDITH T.TERRY ®� P,�� FAX(516)765-1823
TELEPHONE(516)765-1801
TOWN CLERK
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. 1418-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner NUHFER, DELMER F.
Mailing Address 1 P. O. BOX 743
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 600 CEDAR DRIVE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-2922
Tax Map No. section 78.00 block 9 lot 6.000
Cross Street MAIN BAYV I EW ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 3/16/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
:+y.
s h.
OFFICE OF THE TOWN CLERKFO(;r°CQ -
Town of Southold ' Application No.. /Li //
Judith T. Terry, Town Clerk � - 41‘) $10.00 - Residential
Town Hall, 53095 Main Road .
P. O. Box 1179 u-3 :_ t ,;r' ' $25.00 - Non-Residential
Southold, New York 11971 %-.444-0);°.� $
Telephone _01 ,. ._',
'tel _.� ; ��°.
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE / 4Re`i-/ /S-/ /99'o
OWNER NAME: Et..6yvF. NwiF
OWNER MAILING ADDRESS: '2O. ( cs `143
)`.)--rN-0 ilUT-1il UT-1i
OWNER- PROPERTY ADDRESS: CSC O
OWNER TELEPHONE NUMBER: -1(0S-a902z.
TAX MAP NO. : Section Q 78 Block 0 9 Lot ® (,
CROSS STREET: d'V\AIN) `SAN,,\ ew
TYPE OF SYSTEM: =Septic Tank' New Existing
Cesspool New Existing X
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: c(\-)pV
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 Appli ant
RECEIVED BY:
own Clerk's Office
DATE: 3 ((e_/ qG
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