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JUDITH T.TERRY � 'd' Town Hall, 53095 Main Road
TOWN CLERK y - P.O. Box 1179
t Southold,New York 11971
REGISTRAR OF VITAL STATISTICS ® �
MARRIAGE OFFICER y� ®�'�1 Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER `_ ®,` * 4:11.6
Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3661-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner WECHTERMAN, IRA P.
Mailing Address 1 3 UVA WAY
Mailing Address 2
City St Zip PORT JEFFERSON NY 11777-0000
Property Address 1 630 OAK STREET
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-331-3184
Tax Map No. section 136.00 block 1 lot 42.001
Cross Street HARBOR LANE
Issue Date: 7/23/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
V "'.
OFFICE�OF THE TOWN CLERK %c5vFFU(,t ��� /
Town of Southold �� Celj'; Application No.
Judith T. Terry, Town Clerk ���, ,.'
Town Hall, 53095 Main Road -� $10.00 - Residential ✓
P. O. Box 1179 v' • • $25.00 - Non-Residential
Southold, New York 11971 4�fo. A aOy�,�`�
Telephone _ ( yi
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
• DATE
OWNER NAME: Q, A 2 )&/--1-Fq nn
OWNER MAILING ADDRESS: /)/A P t _
�/-"/ 7 /i777
OWNER PROPERTY ADDRESS : (g7L--
G14c0 . f
OWNER TELEPHONE NUMBER: f---/Z
- 4//4/)
TAX MAP NO. : Section Block Lb I a
• CROSS STREET:" " 9-
TYPE OF SYSTEM:. Septic_ Tank - New Existing
Cesspool ,/ New Existing
Residential t� 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.)
4116
eti
Signature of Applicant
RECEIVED BY: _ _
• Town' Clerk's Office
DATE:
SURVEYED FOR:- '//e34 ' //-7/ ""Z "---A./E- y1/-c"W.7"E C:', Z4,.y
LOCATED AT C^LiTCf/O�� . .. , TOWN OF LI77-7OLfl
LOTS /O 27/28. e / Y1d.siv , , '1 - _- '•
MAP OF JE // 7/ '7" - _ , CO. CLK. N i
SCALE 1" = 20' - - _
SUFFOLK CO. TAX MAP DATA:- +
DIST. /COO , SEC. /. ..00 - ��� '
BLK. O/C:-:>$0 LOTS ���O ���
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0
m .30 /O ''
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To :Ywl.}:7 zz Y,C C, ,,�� .'.DitiY flu Cr-.„`], Lli .�
ON
SPECRC USE) ONLY, AND /fr S/ j, rt!I
SHOULD NOT BE USED FOR �y // N E Uw
CONSTRUCTION OF FENCES k tj�l� �'P� � �6 i?/ LU
OR OTHER STRUCTURES. (n - --, 9y
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