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Home My WebLink AboutBratle X �r JUDITH T. TERRY � = ? Town Hall, 53095 Main Road TOWN CLERK ' y ,1 i; P.O. Box 1179 REGISTRAR OF VITAL STATISTICS + Southold, New York 11971 MARRIAGE OFFICER a= :q' ''� � Fax (516) 765-1823 �'.•a ,`� Telephone (516) 765-1801 ti OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 1618-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner BRATLE, CARL G. C SHIRLEY E. Mailing Address 1 P. O. BOX 1154 Mailing Address 2 City St Zip SOUTHOLD NY 11971-0000 Property Address 1 775 HILL ROAD Property Address 2 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 516-765-1078 Tax Map No. section 70.00 block 4 lot 27.000 Cross Street WELLS AVENUE Date Of Last Pump Out 0/00/00 Issue Date: 1/17/91 Judith T. Terry Southold Town Clerk (TOWN SEAL) OFFICE OF THE TOWN CLERK Fair if Town of Southold %cs31. � '- Application No. //f/ V Judith T. Teary, Town Clerk % /..-_,4:1;:;;;' ):.,....41\ Town Ha'ut, =53095 Main ` :G $10.00 - Residential Road � �--E p. 4. Box 1179 u7 = `t �:� $25.00 - Non-Residential Southold, New York 11971 p *.1,, Telephone .0/� � (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. • Fee $ • DATE i2 - 7-gO 'OWNER NAME: CA AZ.1, G ti.RL to E. 13 IA i kE • OWNER MAILING ADDRESS: 47-7E" HLk), It!) t P-6, 46 k -1lJr'`� S-nuitWO/Lb, Ay. ` // 9V OWNER PROPERTY ADDRESS: ,4_,1 s k-011 E OWNER TELEPHONE NUMBER: s t�O �'�' j"- TAX MAP NO. : Section -17O Block 1J Lot 01'7 CROSS STREET: YV l~1,,1.s TYPE OF SYSTEM: Septic Tank i✓ - New Existing _ Cesspool g New Existing Residential � Non-Residential DATE OF PREVIOUS PUMP-OUT: Np i1 - ` f 7- M-a 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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