HomeMy WebLinkAboutBodenstein / ����..�
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JUDITH T.TERRY / t Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
�� Southold,New York 11971
REGISTRAR OF VITAL STATISTICS VI. 47$ Fax(516) 765-1823
MARRIAGE OFFICER `. y
RECORDS MANAGEMENT OFFICER ;� i
®,( * '°01°'� Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER ,,,,,
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3642-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner BODENSTEIN, ELEANOR
Mailing Address 1 6135 INDIAN NECK LANE
Mailing Address 2
City St Zip PECONIC NY 11958-0000
Property Address 1 6135 INDIAN NECK LANE
Property Address 2
City St Zip PECONIC NY 11958-0000
Owner Telephone No. 516-734-6298
Tax Map No. section 86.00 block 6 lot 19.000
Cross Street WOOD LANE
Issue Date: 5/29/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
II IIS
OFrICE OF THE TOWN CLERK c,VWFO(,� -
'
Town of Southold ® CDG,� Application
Judith T. Terry, Town Clerk �� 4Ft �z .t41.
Town Hall, 53095 Main Road cgs = y, + r< 1 $10.00 - Residential
P. O. Box 1179 ItZ4N ;' $25.00 - Non-Residential
Southold, New York 11971
Telephone 01 `\��1
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /0
DATE 1.-2-6 /I/7-
Y
OWNER NAME: ri t® . & (-d e_1 sf-e-C
OWNER MAILING ADDRESS:
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: V3c1 623T7
TAX MAP NO. : SectionBlock 6 Lot /
CROSS STREET: ,7,4
TYPE OF SYSTEM: Septic Tank r New Existing
/
Cesspool �✓ , 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.)
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Signature /of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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