HomeMy WebLinkAboutYoerges OD
Town Hall, 53095 Main Road
P.O. Box 1179
y,�, ,% Southold, New York 11971
JUDITH T.TERRY � TELEPHONE
TOWN CLERK �!���/ /fi (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. 901-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner YOERGES, FRED C. AND WIFE
Mailing Address 1 BOX 1427
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 DEER DRIVE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-9134
Tax Map No. section 114.00 block 10 lot 12.000
Cross Street CINDY LANE
Date Of Last Pump Out 0/00/79
Issue Date: 11/01/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK C� MA'
Town of Southold �, C'sG� , Application No. 9 d /
Judith T. Terry, Town Clerk e'*-- L_h y
Town Hall, 53095 Main Road —1 « :- -'� Residential 1/-
p.
p. O. Box 1179
� ,.y;;..•: .�`�" ,�� Non-Residential
i`4��=
Southold, New York 11971 O
Telephone ,� 4114--
(516) 765-1801
TOWN OF SOUTHOLD
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SOUTHOLD WASTEWATER DISPOSAL DISTRICT
• APPLICATION
- for - - - - _- -
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /0
DATE rr,
OWNER NAME: -MA * in/ZS t / / C ,Y06/2.6'6
OWNER MAILING ADDRESS: 701 , `' P'1 4i r
WI A, 4-4 / • C, 11 1 r
OWNER PROPERTY ADDRESS: ‘ v,
r2v
71/1 04.a /u• 'f /( CPc v
OWNER TELEPHONE NUMBER: re r Lq-f' 9 /� y
Ave
TAX MAP NO. : Section Block /6) Lot glterej =G e71`
CROSS STREET: C (w=ett L &1 E_
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool C� New Existing
Residential i.0 Non-Residential
DATE OF PREVIOUS PUMP-OUT: ul r S -
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.)
Signature of Applican
RECEIVED BY: AgrzAwa�1�
To n Ci rk s • i ce
DATE: f .6/2. 7/2,!?
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