HomeMy WebLinkAboutDroeger Town Hall, 53095 Main Road
'' I P.O. Box 1179
���� Southold, New York 11971
JUDITH T.TERRY _�, /�i!o FAX(516)765-1823
TOWN CLERK TELEPHONE(516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1297-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner DROEGER, WILLIAM H.
Mailing Address 1 215 EAST 17TH STREET
Mailing Address 2
City St Zip NEW YORK NY 10003-0000
Property Address 1 2965 LIGHTHOUSE ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-2320
Tax Map No. section 50.00 block 3 lot 12.000
Cross Street PRIVATE ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 11/08/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
OFFICE OF THE TOWN CLERK ocvFFO(,'�'=
Town of Southold �� C'Q Application No. n-9/
Judith T. Terry, Town Clerk •
Town Hall, 53095 Main Road k� $10.00 - Residential
P. O. Box 1179 (' ` ;.;, y
Southold, New York 11971 OVA , '' ���� $25.00 - Non-Residential
Telephone �� y ‘6
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /0/DO
DATE ///��/�/
•
1
OWNER NAME: /(}lL/04 //•
OWNER MAILING ADDRESS: .1-is) 4= • /7 Tr/ Jl
,UE - '6aK, ,fit`, /00o3
- OWNER PROPERTY ADDRESS: �C�J i� 0/ / lOSt - —
J T� L j ,(J.,V
OWNER TELEPHONE NUMBER: 1 ta5
TAX MAP NO. : Section , b Block Lot 1 1^
CROSS STREET: 'Pp/VA-TL LOU
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool V New Existing `/
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: /9(fg
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 Applicait
RECEIVED BY.:
Town Clerk's Office
DATE:
NOV 0 8 198
Tom Clerk MOW