HomeMy WebLinkAboutSchneider, Kenneth ,, �o� SUfFO1�-
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ELIZABETH A.NEVILLE ��j yd Town Hall, 53095 Main Road
TOWN CLERK ` y P.O. Box 1179
REGISTRAR OF VITAL STATISTICSPrt
Southold, New York 11971
MARRIAGE OFFICER ifi !`F,11 Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER � � a�'i� Telephone (631) 765-1800
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FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
SOUTHOLD TICAS/11106033REEIMIDSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4078-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner SCHNEIDER, KENNETH
Mailing Address 1 1005 MASON DRIVE
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 1005 MASON DRIVE
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 631-734-2227
Tax Map No. section 104.00 block 5 lot 36.000
Cross Street HAYWATERS DRIVE
Issue Date: 4/18/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
ti
s
OFFICE OF THE TOWN CLERK COFCL4' t,(
TOWN OF SOUTHOLD ,� Application No. < 6
76
ELIZABETH A.NEVILLE,TOWN CLERK � $10.00 - Residential
P.O.BOX 1179
SOUTHOLD,NEW YORK 11971 � $25.00 - Non-Residential
Telephone _�j * `1'k•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE /0710/
eenneg
OWNER NAME: gcle-)61-er
OWNER MAILING ADDRESS: `GOA / GtSovt Dr.
G uIc.A o5 L)e/ A) / I 1 q35
OWNER PROPERTY ADDRESS: /O05. Mason dir
OWNER TELEPHONE NUMBER: 73q-Zi7v
TAX MAP NO. : Section /0 171 Block S Lot 3 C
CROSS STREET: /1/4)/0a, 7ers' Dr/ tie,
y
TYPE OF SYSTEM: Septic Tank V New V Existing
Cesspool New Existing
/
Residential V 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.)
aft.,Signatur of Applicant
RECEIVED BY: E _J
own rk's Office
DATE: Ai/ 1.
I
Septic Tank
Operation Permit
\inkLocation4/17/2001 Map
35'
56' 19' 21 19
Scaled'=20'
41'
p
Kenneth Schneider
1005 Mason Drive
50' Cutchogue, NY 11935
SCTM #1000-104-5-36
Mason Drive