HomeMy WebLinkAboutUhlemann 111''I®c� o �® -`
`� �� Town Hall, 53095 Main Road
`Y® ��` P.O. Box 1179
®d 41 ��®��� Southold, New York 11971
JUDITH T.TERRY �''-~0/0.- TELEPHONE
TOWN CLERK (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. 710-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner UHLEMANN, ELIZABETH
Mailing Address 1 BOX 196
Mailing Address 2 BAYVIEW AVENUE
City St Zip MATTITUCK NY 11952-0000
Property Address 1 BAYVIEW AVENUE
Property Address 2 SHORE ACRES
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-4971
Tax Map No. section 106. 00 block 11 lot 16. 000
Cross Street SOUTH DRIVE
Date Of Last Pump Out 0/00/84
Issue Date: 5/20/88 Judith T. Terry
Southold Town Clerk
N
(TOWN SEAL)
OFFICE OF THE TOWN CLERK gCOFi 9
Town of Southold f CQ Application No. 7.&/
� •,. lj pP
Judith T. Terry, Town Clerk �� jt4-4 1..I Residential
Town Hall, 53095 Main Road n -
r �' '
P. O. Box 1179 c �.-. �� '� � Non-Residential
�
Southold, New York 11971 tc12; 4 � �•`
Telephone _ j pag-
tal
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERAT ION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
/d -—
Fee $ ,
DATE 5://-
OWNER
: /7 -OWNER NAME: et l2- /94 t7 Zj/YLe---;(1111-/1"/1-
OWNER MAILING ADDRESS: S/71J2 E C 's s )( X91
OWNER PROPERTY ADDRESS: S e,E5
/4
OWNER TELEPHONE NUMBER: u"` ' 97/
j
TAX MAP NO. : Section /o Block // Lot //,‘
CROSS STREET: Acyp/Eid /97, goti
TYPE OF SYSTEM: Septic Tank New, Existing
Cesspool ' X New . Existing
Residential X , Non-Residential
DATE OF PREVIOUS' PUMP-OUT: � 94e
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.)
9/ r.frZer/ 0//4/,' ,‘,..ee0.-.-..
I/
Signature of Applicant
RECEIVED BY:Ga
EC�
ljv ownblerk's , ice
DATE: MAY 2 01988 •
Town OltrK Southold
• -
. •_
•
•
- _
1
• S Opt
r-a•coe
/.5 3/ ' ,; Pe „Ili
fro
5 2_ i
ecs s
• 0 0
PU
aPtfiniP
w.NN
M
c,10thiwt?