HomeMy WebLinkAboutWelz Pi"
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EilIZABETH A.NEVILLE ® 1'4 Town Hall, 53095 Main Road
TOWN CLERK y 2 P.O. Box 1179
CP �'l Southold,New York 11971
REGISTRAR OF VITAL STATISTICS : 1
y oI Fax(516) 765-1823
MARRIAGE OFFICER ;�QAlig ®�( �a�ei� Telephone(516) 765-1800
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3813-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner WELZ, JANE E.
Mailing Address 1 1650 HORTON LANE
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 1650 HORTON LANE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-1405
Tax Map No. section 63.00 block 1 lot 14.000
Cross Street MAIN ROAD & ROUTE 48
Issue Date: 9/11/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
9 # " ���
OFFICE QF THE TOWN CLERK c3VFFU(,r
LIZABETH A.NEVILLE,TOWN CLERK �JOHN OF SOUTHOLD �O ,.COQ� - Application No.3 ��
Pr .•C $10.00 Residential X
P.O.BOX 1179
SOUTHOLD,NEWYORK11971 0 *-',�I $25.00 - Non-Residential
-- Telephone ° '--r, - , S *
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERAT ION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 35/
Fee $10.0 0
DATE
OWNER NAME: t !E E ° VJE 1-2--
OWNER
- ZOWNER MAILING ADDRESS: /,5-0 b j-0,J ,C.A'iv'E
5o oto 1<� N y° / 197- I
OWNER PROPERTY ADDRESS: SA-,E
OWNER TELEPHONE NUMBER: Cb(6} 7-65 — /406--
TAX
40sTAX MAP NO. : Section /000 Block Lot / /T
CROSS STREET: $ET1✓E ( ' 1l-fnl RD ( 7 2s) �(-' PTE- ifg
TYPE OF SYSTEM: Septic Tank New - Existing
Cesspool X New Existing X
Residential X 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.)
6FG•ps---I CA) /
Signature •, applicant
RECEIVED BY: -
• To n Clerk's Offi ,
DATE: 9/X
4