HomeMy WebLinkAboutWanat t'14j'11f4PULAr�®
Town Hall, 53095 Main Road
_� P.O. Box 1179
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` Southold, New York 11971
JUDITH T.TERRY poi. TELEPHONE
TOWN CLERK .ii (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. 827-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner WANAT, JOSEPH A.
Mailing Address 1 RFD 1, BOX 247
Mailing Address 2 BERGEN AVENUE
City St Zip MATTITUCK NY 11952-0000
Property Address 1 BERGEN AVENUE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-4560
Tax Map No. section 112. 00 block 1 lot 16. 001
Cross Street SOUND AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 9/13/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE, OF THE TOWN CLERK
c�vFFOI
Town of Southold � BOG Application No. 202
Judith T. Terry, Town Clerk �� , 4. y
Town Hall, 53095 Main Road o { '* v -bi -< 7 Residential
P. 0. Box 1179 u' 7 •
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ss ��„�,�.• •• Non-Residential
Southold, New York 11971 %;f4,
Telephone Q( irld •
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
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APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /sOf
DATE 611il88
• OWNER NAME: J13S61)14 Vs iN Il-
OWNER MAILING ADDRESS: ItFt) 101, 1 e.rleT\ 4442.hut.
Rte'\' L Lt �y 1 Ilg5 a.
OWNER PROPERTY ADDRESS: Z! f l. N‘IGryu6`
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OWNER TELEPHONE NUMBER: 516 A% 4, S60
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TAX MAP NO. : Section Block Lot
CROSS STREET: RD E (tkok'Tvi S®L.o. Merkur)
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing X
Residential xNon-Residential
DATE OF PREVIOUS PUMP-OUT: -.J\\u\1/4\ k.q8't
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.)
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'signature of Applica t
RECEIVED BY: °zci .
Town erk's Office
DATE: FLFCEI ?'®
S;:? 13 1g8�
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