HomeMy WebLinkAboutAnderer (2) �QF s��ry
ELIZABETH A.N+IEVILLE �"" �► D Town Hall,63096 Main Road
TOWN CLERK ~ F.O. Boat 1179
REGISTRAR OF VITAL STATISTICS Southold,New York 11971.
MARRIAGE OFFICER ` ; Fax(631) 766-6146
RECORDS MANAGEMENT OFFICER ;�, Telephone(631)7WI800
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4368-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner PETER ANDERER
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Mailing Address 1 600 BROWN STREET
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Mailing Address 2
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City St Zip GREENPORT NY 11944-0000
Property Address 1 1320 SEVENTH STREET
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Property Address 2
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City St Zip GREENPORT NY 11944-0000
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Owner Telephone No. 631-477-1967
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Tax Map No. section 48.00 block 3 lot 18.001
Cross Street 7TH STREET & BROWN STREET
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Issue Date: 1/30/08 Elizabeth A. Neville
-------- Southold Town Clerk
(TOWN SEAL)
ELIZABETH A.NEVILLE �� Town Hall, 53095 Main Road
TOWN CLERK coo Z P.O. Box 1179
REGISTRAR,OF VITAL STATISTICS O Southold, New York 11971
RECORMARRIAGE
S RMANAGEMENT OFFICER y� aO�� Telephone Fax 163 765-6145
5765 1800
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FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
OPERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @ $10 or Non-Residential @ $25 Application No.
Permit No. co 2
35� �
Owner Name
Owner Mailing Address o 0 &0'4N
Owner Property Address f 3 A O
Owner Telephone No.
Tax Map No: /OT)o Section 8 Block 3 Lot 8 . 1
Cross Street ? )- &&, S.;r
Please check each that applies: New Construction
Alteration to Existing System
Residential Non-Residential
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. (Locate
building and system; give north arrow and approximate distance in feet from system to building
and closest road. New construction may submit copy of survey with SCHD approval.)
IJ6 14-
6-3- C)
Signature of A licant Date
Received by: