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JUDITH T.TERRY � _ '��: Town Hall, 53095 Main Road
TOWN CLERK ; y 2 ; P.O. Box 1179
REGISTRAR,OF VITAL STATISTICS
MARRIAGE OFFICER `�wO�° ���.4Southold,New York 11971
Fax(516)765-1823
RECORDS MANAGEMENT OFFICER = ®.� ��®�0 Fax
(516) 765-1800
FREEDOM OF INFORMATION OFFICER4.„�
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3751-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner BIELER, JOYCE ANN AND FRANK
Mailing Address 1 20 LAKEWOOD AVENUE
Mailing Address 2
City St Zip RONKONKOMA NY 11779-0000
Property Address 1 FRED STREET
Property Address 2
City St Zip NEW SUFFOLK NY 11956-0000
Owner Telephone No. 516-981-8779
Tax Map No. section 117.00 block 4 lot 20.000
Cross Street FANNING ROAD
Issue Date: 12/31/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN Cl_LR K ,3 c'\\(f-U(/' 3 7`j
Town of Southold �� 4 . Applir :,tion No.
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IIi«i;rr^.
Judith T. Terry, town Clerk
Town Hall, 53095 Main Road ;� °n�� �`; ! $10.00 _ Residential_ r/
P. O. Box 1179 cn ';�eY+l ii�irir ��' ' ► $25. 00 - Non--ResidentialSouthold, New York 11 971 O q'�l�1 '� ��
Telephone Q./ � • ,•� y�,i
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
..5 /4"/
Operation Permit No. /�//J /� ter)
d.
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Fee $ T.1/ �`E� oZ
DATE /diatIG 7
OWNER NAME: /C `ci"f 'L1taje4)
OWNER MAILING ADDRESS: �Q U
OWNER PROPERTY ADDRESS : -
1,1
OWNER TELEPHONE NUMBER : 9r/ Cf9 2 9'
TAX MAP NO. : Section // 7 Block 9 Lot c24
CROSS STREET : �- 9
TYPE OF SYSTEM: Septic Tank r/ New ✓ Existing
Cesspool _-_L/_ New V Existing `
Residential _L _Non--Resiclential
LOCATION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow and feet
of distance, al)l)Foxinr.itely, to building and closest road. )
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SUI1VEYED.-DEC.!? 1935
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MAP"-A-1?1M)E0-OCT 30,1186
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