HomeMy WebLinkAboutWissmann ®c3FFoUrisi
JUDITH T. TERRY ; Town Hall, 53095 Main Road
TOWN CLERK v T P.O. Box 1 179
REGISTRAR OF VITAL STATISTICS % Southold, New York 11971
' �' ��, Fax (516) 765-1823
MARRIAGE OFFICER
',�Ol 'p b .' Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 2078-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name rOf Owner WISSMANN, ROBERT 8 CHARLOTTE
Mailing Address 1 715 GULL POND LANE
Mailing Address 2
City St Zip GREENPORT NY 11944-2417
Property Address 1 37 SUNSET LANE
Property Address 2
City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 000-000-0000
Tax Map No. section 33.00 block 4 lot 50.000
Cross Street SUTTON PLACE
Date Of Last Pump Out 0/00/00
Issue Date: 3/18/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK 'S�FFO(,t-��- /�
Town of Southold re % Application No.OrU 7u
Judith T. Terry, Town Clerk • ti J ``
Town Hall, 53095 Main Roadx �'� _ .,< : I 10.00 Residential
P. O. Box 1179 u' ® cf''. �•• $25.00 - Non-Residential
Southold, New York 11971
Telephone �%
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE
OWNER NAME: etift/ `
OWNER MAILING ADDRESS: ,/$ ihkle Pracx efAe.E.-Adeiw
- 27; //9515/—,,2'1/7
OWNER PROPERTY ADDRESS: 3
7Z //9J/ p27
OWNER TELEPHONE NUMBER:
TAX MAP NO. : Section 35 Block Lot J---Q
=CROSS STREET:
.
TYPE;OF SYSTEM-:-- SepticTank _ -- New Existing Z
Cesspool New Existing t
Residential V Non-Residential
DATE OF PREVIOUS PUMP-OUT: 3-9
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.) �-
LJr ST /d 0 /74-
,
----1-71/0R-rm-
• I 2
Signature of App icant
RECEIVED :BY , _ - •
Town Clerk's Office
-- --
DATE: - - : - --- --------- -