HomeMy WebLinkAboutWockenfuss 0. (V
JUDITH T. TERRY F Town Hall, 53095 Main Road •
TOWN CLERK r P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER G i!' Fax (516) 765-1823 •
�® �! 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. 3057-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner WOCKENFUSS, JANET
Mailing Address 1 BROWN, RUTH
Mailing Address 2 P. O. BOX 30
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 2386 HYATT ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-3798
Tax Map No. section 54.00 block 1 lot 4.000
Cross Street SOUNDVIEW AVENUE
Date Of Last Pump Out 5/00/84
Issue Date: 7/05/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
\
�. or .'' '
OFFICE OF THE TOWN CLERK S�FFair
L' Application No. �J
Town of Southold �O .,. Ql/ pp
Judith T. Terry, Town Clerk _ ; k: y
Town Hall, 53095 Main Road = ` '„”;' ''� $10.00 - Residential
P. O. Box 1179 (!7 . Of?'-;:'7.' • ��
$25.00 - Non-Residential
Southold, New York 11971 O V--. + ��II
Telephone ( Y►
(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: : I e•r VVocP el-% , 2 Le- Imo- Z. s r
OWNER MAILING ADDRESS: P. ®. 6 h,e_ 3o
-rio1e/ NY 11771
OWNER PROPERTY ADDRESS : 2354 hi-et , C
5e) 1,41-1L1tTv 11 1
OWNER TELEPHONE NUMBER: S.-16- 16C- '3-7 9(
TAX MAP-NO. : Section ��`/ Block / Lot
CROSS STREET: So ii w...G(vt, Alle-
-
TYPE OF SYSTEM: Septic Tank New Existing i. "---
Cesspool
./Cesspool New Existing
Residential " Non-Residential
. DATE OF PREVIOUS PUMP-OUT: l— $14
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.))
gia'r- Wi-74----- 4,-,--i
• Signature of Applican
.-
RECEIVED
RECEIVED BY: . (/0/-144-%-- '
n Clerk's Office
DATE: 72V� P-9
•
•
ca
7
®i,rS