HomeMy WebLinkAboutUmbach 4 'gOFFOLAO
JUDITH T.TERRY G'y
• Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS O ��
MARRIAGE OFFICER �4* O''•, Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER Q( 4 �
I� 1.1 Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER -- St's'
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3657-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner UMBACH, CHARLES J. AND NANCY
Mailing Address 1 152 BROMPTON ROAD
Mailing Address 2
City St Zip GARDEN CITY NY 11530-0000
Property Address 1 675 OLD MENHADEN ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-711.7-8136 /
Tax Map No. section 111 .00 block 7,o0 lot 21 .000
Cross Street WUNNEWETA ROAD
Issue Dat: . 7/23/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
i r eit/4FFO`ic
JUDITH T.TERRY 1 h� tk Town Hall, 53095 Main Road
TOWN CLERK ® P.O. Box 1179
coo
� Southold,New York 11971
REGISTRAR OF VITAL STATISTICS O "V 0 Fax(516) 765-1823
MARRIAGE OFFICER \y /RECORDS MANAGEMENT OFFICER _�lolJig `1►`0,0 Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER .006
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD _ F
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3657-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner UMBACH, CHARLES J. AND NANCY
• Mailing Address 1 152 BROMPTON ROAD
Mailing Address 2
City St Zip GARDEN CITY NY 11530-0000
Property Address 1 675 OLD MENHADEN ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-747-8136
Tax Map No. section 111 .00 block 1 lot 21 .000
Cross Street WU N N EWETA ROAD
Issue Date: 7/23/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERKFD
Town of Southold : - I`CQG Application No.�IO/
�7
Judith T. Terry, Town Clerk �� �, ;.. l y
Town Hall, 53095 Main Road {` :' 1 $10.00 - Residential
P. O. Box 1179 u' ,z ' ; ��' $25.00 - Non-Residential
Southold, New York 11971e�`
Telephone -'70/
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE -7%17
OWNER NAME: C=//'LS \77. j//1"W,e7- Zr-r&Z,fe�.�
OWNER MAILING ADDRESS: /5—,2 Qv�D/� 7 4J ,fid 3
&7110: Xi,-
- OWNER PROPERTY ADDRESS: e 7 D G'_✓ ✓J��' � �
v;-2-d,,740�6,-4- Air y,
OWNER TELEPHONE NUMBER: .5 /6 —7)7—(P/-7:4
TAX MAP NO. : Section /77
7 Block 0 ? Lot c:V
CROSS STREET: 4)42,U C� '�7,,� e..4)
TYPE OF SYSTEM: Septic Tank `( New Existing ?e-
Cesspool y New s Existing
Residential Non-Residential
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.)
Signatu'r of Applicant
•
RECEIVED BY:
Town Clerk's Office
DATE:
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,y + yOcl .r , I Section 7209 of the New York State f^
1. '.•'f �..o:,...w' t c 1 Education Law.
. , - 'S Copies of this survey map not bearing,”
the land surveyors Inked seal or ''-;',,I,
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31 a' >' 1 title company,governmental agency and I
-•- „� ; lending institution listed hereon and '
.•1 ti _ ( f to the assignees of the lending insti- I
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