HomeMy WebLinkAboutWertenbert OFFICE OF THE TOWN CLERK ' cigaro-
Town of Southold
Judith T. Terry, Town Clerk • , Ff S`
Town Hall, 53095 Main Road f '„
P. 0. Box 1179 c.n
Southold, New York 11971 F �•
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 339 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool X
NAME OF OWNER: Evelyn C. Wertenbert
OWNER MAILING ADDRESS: Box 833
Mattituck, New York 11952
OWNER PROPERTY ADDRESS:375Racoon Road, Hide Away Estafes':
Mattituck, New York
OWNER TELEPHONE NUMBER: 516-298-4324
TAX MAP NO. : Section 106 Block 10 Lot 10
CROSS STREET: Miller Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
• DATE OF PREVIOUS PUMP-OUT: Never•Previously Pumped
Judith T. Terry
Southold Town Clerk •
DATE: , July 1.5, 1987 - -
(TOWN SEAL)
OFFICE OF THE TOWN CLERK C��FFU(��'- 2
Town of Southold �® CQG Application No<.53
Judith T. Terry, Town Clerk �� + s'. � •.'
• V 4 - ,.C`1 Residential
Town Hall, 53095 Main Road ,�%5 {j�}s
P. O. Box 1179 (r3 ',7i-.". > s '�'h Non-Residential
Southold, New York 11971 O ®3 ®�'..`
Telephone ; d
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3/44`8-7
Fee $ • c�
DATE ta,: 4 p / Ul
OWNER NAME: 1 rp..J C - )11J1-"4- e-J,f-edl
OWNER MAILING ADDRES :p..., 5'33
3--7S- te-0'- -
OWNER PROPERTY ADDRESS: yGP�I,C`�
C
OWNER TELEPHONE NUMBER: -4r.-- .3 2/541
TAX MAP NO. : Section /0 (a , -- Block / 0 — Lot /
CROSS STREET: 7 c e-QP..`' l'°k_
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool V New Existing V'
Residential ` Non-Residential
DATE OF PREVIOUS PUMP-OUT: -)4.-6-,-a—
LOCATION
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.)
0. ' /t
ignature of Applicant
IrC-.173--/ I
RECEIVED BY:
Town Clerk's Office
DATE:
C .376
isigaw:i c-Q,e,c, -Li" -
i ifP)1414"114. ct .--L e-L-rec th.::e-lie-o ,t-- 1.7(..*-1,,_ ..,,...al--e,<, . 6--/-z..‘,..--&,143.,
20 P >G & , . "ALA. ,::_- •--2<_.g.-4,24S1. ein-4-,-.2 t.toc
f I
/l
_146j-1;:______,--y
4 6jV
L
1 11
1 i i Ili - 4 4-n'-"
S C6(41(
1:I
\ , 91-` V friLf
1
1