HomeMy WebLinkAboutUhlinger Ce
JUDITH T. TERRY ,� y� Town Hall, 53095 Main Road
•
TOWN CLERK Z P.O. Box 1179
•REGISTRAR OF VITAL STATISTICS T � Southold, New York 11971
MARRIAGE OFFICER Fax (516) 765-1823
�® .t, Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1727-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner UHLINGER, THOMAS AND KAREN
Mailing Address 1 P. O. BOX 1025
Mailing Address 2 •
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 12370 OREGON ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-5282
Tax Map No. section 83.00 block 3 lot 7.001
Cross Street COX LANE
Date Of Last Pump Out 0/00/00
Issue Date: 7/24/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK s\TFfJL4
Town of Southold �® CQG' , Application No.
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road -� $10.00 - Residential
P. O. Box 1179 u' ' ► ; $25.00 - Non-Residential
Southold, New York 11971 O�l��•rv01
`
Telephone _ I .9
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ ® °'
\ }'
DATE 74/d /
OWNER NAME: 'I-24,,di ,� / iCe^I 0746, i e,
OWNER MAILING ADDRESS: 09,,(. Bax /Da5'
e J7'644 6-de, AU Y. //9.fr
-OWNER PROPERTY ADDRESS: - W70 -r:-.),Re6-aAl kb --
OWNER TELEPHONE NUMBER: 77i—s 't)
TAX MAP NO. : Section Block 3 Lot .7v
CROSS STREET: 6'0
TYPE OF SYSTEM: Septic Tank New Existing
‹Cesspool New Existing S
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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: /4/ �`.
Town Clerk's Office
DATE: 77/ c ./9j
L,-5.
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