HomeMy WebLinkAboutWuensch ,I
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i Town Hall, 53095 Main Road
G, 0 P.O. Box 1179
Southold, New York 11971
JUDITH T.TERRY ��� ��-�- TELEPHONE
TOWN CLERK (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. 3575-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner WUENSCH, SHEILA
Mailing Address 1 460 WEST VIEW DRIVE
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 460 WEST VIEW DRIVE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-7404
Tax Map No. section 139.00 block 1 lot 13.000
Cross Street BROWER ROAD
Issue Date: 1/17/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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of Si, /Ii.I
OFFICE OF THE TOWN CLERK CO MX
Town of Southold — COG Application No. �5
Judith T. Terry, Town Clerk .� ��
�- ,G $10.00 - Residential •Town Hall, 53095 Main Road *f:,, 3'
P. O. Box 1179 v' w '' � � ` � $25.00 - Non-Residential
Southold, New York 11971 O ,r � 1�`
Telephone 414
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /0
DATE
OWNER NAME: S -K:7L4 /i"2iG#
OWNER MAILING ADDRESS: 96 CJS‹1,1ec-) 0e/ V
//9�
OWNER PROPERTY ADDRESS:_
OWNER TELEPHONE NUMBER: -s '
TAX MAP NO. : Section i4 —/—/3 Block Lot
CROSS STREET: ek,04,2M "
TYPE OF SYSTEM:- 'Septic `Tank - '-" - New Existing,__
Cesspool X New Existing
Residential____ 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.)
/JP-C.1
Signat re of Applicant w
RECEIVED BY: AZ / l - _
•" - - Town Clerk's 0 e -
DATE: ( ( / 7797
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