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Home My WebLink AboutZeller s � �QF SQur ELIZABZM A.NEVU LE,RMC,CMC Town Hall, 53095 Main Road TOWN CLERH P.O. Box 1179 REGISTRAR OF VITAL STATISTICS Southold,New York 11971 MARRIAGE OFFICER Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER Telephone(631) 765-1800 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. 4387-R Residential X Non-Residential Fee $ 10.00 New Existing X Name Of Owner RUTH ZELLER ------------------------------ Mailing Address 1 225 WILLOW STREET ------------------------------ Mailing Address 2 ------------------------------ City St Zip CUTCHOGUE NY 11935-0000 Property Address 1 225 WILLOW STREET ------------------------------ Property Address 2 ------------------------------ City St Zip CUTCHOGUE NY 11935-0000 Owner Telephone No. 631-734-7726 ------------ Tax Map No. section 103.00 block 7 lot 8.000 Cross Street STILLWATER AVENUE ------------------------------ ---------------------------------- Issue Date: 12/09/08 Elizabeth A. Neville ------ Southold Town Clerk (TOWN SEAL) l ELIZABETH A. NEVILLE �� Ol0 Town Hall, 53095 Main Road TOWN CLERK P.O. Box 1179 REGISTRAR OF VITAL STATISTICS Southold, New York 11971 MARRIAGE OFFICER A Q Fax (631) 765-6145 RECORDS MANAGEMENT OFFICER �� Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER �lif'COU'M southoldtown.northfork.net IIVV 11``, OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION OPERATION PERMIT CESSPOOL or SEPTIC TANK C� Residential @ $10 or L-1 Non-Residential @ $25 L' Application No. Permit No. CR, Owner Name: UT H Zea e _ 3 6 D3 Owner Mailing Address: t A-)I LLOt,c i -T_25ET _ Cv7c too 8 vE _ru(A 11935 Property Address: tqrnF_ Owner Telephone No. 7,324 . 77a& _ Tax Map No.: Section: /03 Block: r) Lot: ow Nearest Cross Street: S71 L(,U)A?E'J6 19DE . Please check all that apply: ❑ New Construction le"Alteration to existing system 1�i- 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 constructionGa bmit opy of survey with SCHD approval.) ure of Applicant Date Received by: COASTLINE CESSPOOL & DRAIN SERVICE 4225 Bridge Lane Cutchogue, L.I.,N.Y. 11935 � N E/IE2 locY 6qL .S T 31 ss' ,�. O 3f o 77 vo o SCCA Lic. #168-LW NYS DEC#1A-600