HomeMy WebLinkAboutBruch !l�
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Town Hall, 53095 Main Road
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�®4H �1 P.O. Box 1179
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rs Southold, New York 11971
JUDITH T.TERRYFAX
O(51NE)765-1823
1801
TOWN CLERK
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. 955-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner BRUCH, FRED AND BARBARA
Mailing Address 1 110 BEVERLY ROAD
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 110 BEVERLY ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-1614
Tax Map No. section 52.00 block 2 lot 16.000
Cross Street NORTH ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 12/13/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK ���
Town of Southold �� CQ ' Application No.
Judith T. Terry, Town Clerk �_ 7 ye
Town Hall, 53095 Main Road '� Residential
P. O. Box 1179 to '. � ; ; hiNon-Residential
Southold, New York 11971 �. '''�*-
Telephone Oj.igt Y► I"
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ 10..00
DATE December 13, 1988
OWNER NAME: Fred and Barbara Bruch
OWNER MAILING ADDRESS: 110 Beverly Road
Southold, NY 11971
OWNER PROPERTY ADDRESS: Same as aboye
OWNER TELEPHONE NUMBER: 765-1614
TAX MAP NO. : Section 52 Block 2 Lot 16
CROSS STREET: None
TYPE OF SYSTEM: Septic Tank New Existing .
Cesspool New Existing XX
Residential XX Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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.)
Go.
Signature of Applicant
RECEIVED BY:
Town CI rk's Of ice
RL CEMD -
DATE:
O 13 1988
TOM Cl sg kir ;'t
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