HomeMy WebLinkAboutWurtz (2) 1,il�r�rllrvr, •���.
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i Town Hall, 53095 Main Road
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' _ � � P.O. Box 1179
_�® ®�i'tSouthold, New York 11971
JUDITH T.TERRY =. `�� �_i�` TELEPHONE
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TOWN CLERK % 11rr1, (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. 903-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner WURTZ, WILLIAM E.
Mailing Address 1 P. O. BOX 122
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 PRIVATE ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-2718
Tax Map No. section 50.00 block 1 lot 6.000
Cross Street SOUNDVIEW AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 11/01/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
OFFICE OF THE TOWN CLERK �FFQ(�. '•
Town of Southold ; CQ Application No. '6,3
Judith T. Terry, Town Clerk �� �'
r r•c I Residential l
Town Hall, 53095 Main Road
P. O. Box 1179 crs �` ; Non-Residential
Southold, New York 11971 6;,
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Telephone _ .�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. ?b3
Fee $ i p ;Ur)
DATE (CA7/0j3
- OWNER NAME: �N c I k"'0,1 - V V ,U RIZ
OWNER MAILING ADDRESS: ? .0 . b o 1/ 0'7(
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1. 11 I X- 1 )-7- + D(fht7(s l6,rt
todf(, o(d A( 1 1
OWNER PROPERTY ADDRESS: 43 gi( 676 Ro/t d
OWNER TELEPHONE NUMBER: 5 f - �� t 5 - 0
TAX MAP NO. : Section 6 a Block Lot (.0
CROSS STREET: Sri l U \ Q l/p
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool 2 New Existing 13u(it ) / C 0
Residential )( Non-Residential
DATE OF PREVIOUS PUMP-OUT: 1U0 n�
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.)
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Signatu a of pplica .
RECEIVED BY: jl/1qAAtn.l , 1 .tc� ,�
Town Clerk's Office
DATE: 1qa-1/81
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