HomeMy WebLinkAboutSchantz, Douglas •0111 cAIFFOLt
ELIZABETH A. NEVILLE ���_� •y�; Town Hall, 53095 Main Road
TOWN CLERK C P.O. Box 1179
REGISTRAR OF VITAL STATISTICS � ,i Southold, New York 11971
MARRIAGE OFFICER :� 1i ����� Fax (631) 765 6145
RECORDS MANAGEMENT OFFICER � �Ql �a�'i� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER _ •1�,
OFFICE ppOONFF�THE ppTOTTWHppNLLDCLERK
SOUTHOLD WASTEW�TERUDISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4047-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner SCHANTZ, DOUGLAS & JANE
Mailing Address 1 350 CONDOR COURT
Mailing Address 2
City St Zip LAUREL NY 11948-0000
Property Address 1 350 CONDOR COURT
Property Address 2
City St Zip LAUREL NY 11948-0000
Owner Telephone No. 631-298-4508
Tax Map No. section 127.00 block 9 lot 14.000
Cross Street WHITE EAGLE DRIVE
Issue Date: 9/13/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK S�FFO(,lr
�� CDS Application No. goq
TOWN OF SOUTHOLD
ELIZABETH A.NEVII.I.F,TOWN CLERK $10.00 - Residential ✓
P.O.BOX 1179
SOUTHOLD,NEW YORK 11971 � Zi $25.00 - Non-Residential
Telephone .01ill 01'
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT e E C E I V E D
SEPTIC TANK or CESSPOOL SEP 1
3
2000
Operation Permit No. Swuffold lawn Clerk
Fee $
DATE
OWNER NAME: V i,.n-� 4-.3 flr.; G' i-i. T
OWNER MAILING ADDRESS:
OWNER PROPERTY ADDRESS: 3 SU 0,2 Q-
�-� Rt Ny X19 (#v
OWNER TELEPHONE NUMBER: S C)
TAX MAP NO. : Section ( Block 1 Lot / *
CROSS STREET: 1.93 N- VTC- ( G -TYPE OF SYSTEM: Septic Tank y New K Existing
Cesspool New Existing
Residential )C 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.)
Signature of Ap-talicant
RECEIVED BY:
own Clerk's Office
DATE:
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