HomeMy WebLinkAboutWenk (2) Town Hall, 53095 Main Road
��� P.O. Box 1179
�'" Southold, New York 11971
JUDITH T.TERRY '-� y��5 FAX(516)765-1823
TOWN CLERK TELEPHONE(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. 1174-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner WENK, RALPH
Mailing Address 1 WENK, MARIE HORAN
Mailing Address 2 BOX 154
City St Zip EAST MARION NY 11939-0000
Property Address 1 260 HUCKLEBERRY HILL
Property Address 2
City St Zip EAST MARION NY 11939-0000
Owner Telephone No. 516-477-1993
Tax Map No. section 31 .00 block 16 lot 5.000
Cross Street BAY AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 6/27/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK
Town of Southold c, C'� Application No. / 1/1' /
Judith T. Terry, Town Clerk .: ` 14
Town Hall, 53095 Main Road ` $10.00 - Residential io,eT0
P. O. Box 1179 ',4#4 • i�; $25.00 - Non-Residential
Southold, New York 11971 O it ��•
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
- - --- OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /' O. Ori)
DATE t7
OWNER NAME ,f}MA tden,��-�''�`
OWNER MAILING ADDRESS: R14, W
, 46'( /3` sf-7i7 i'®n
OWNER PROPERTY ADDRESS: .,6 0 f{r/cfi-f e_/fe,7#! her'i(
OWNER TELEPHONE NUMBER: q'77- /173
TAX MAP NO. : Section 3 ) Block / , Lot S.-
-CROSS STREET: if A¢-(1'eNv-e
TYPE OF SYSTEM: Septic Tank New Existing ��
Cesspool V- New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: 1C f 7
LOCATION MAP: Must be attached hereto beforer i may m t m y be issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
/9 i /tel^!t!1 He, ‘9407r-0--„0 f/Lte—i
•
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE: 6/C® an,ng
JUN 2G111.-,. o
ymn 410/4 Softie