HomeMy WebLinkAboutHaas OFFICE OF THE TOWN CLERK cwFFUCK�►"
Town of SoutholdOG
Judith T. Terry, Town Clerk •
Town Hall, 53095 Main Road k, a
P. O. Box 1179
Southold, New York 11971 `•Q ®;. '��
Telephone ' ®1ift
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 139 Residential X
Non-Residential
Fee $ 10.00
Septic X Cesspool X_ _
NAME OF OWNER: David F. Haas
OWNER MAILING ADDRESS: 275 Sigsbee Road
Mattituck, New YO>rk 11952
OWNER PROPERTY ADDRESS: 275 Sigsbee Road
Mattituck, New York 11952
OWNER TELEPHONE NUMBER: 516-298-5129
TAX MAP NO. : Section 143 Block 2 Lot 6
CROSS STREET: Route 25
TYPE OF SYSTEM: Septic Tank X New Existing x
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: June 1981
Judith T. Terry
Southold Town Clerk
DATE: November 12, 1986
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK cgFO(K /
Town of Southold Application No.
Judith T. Terry, Town Clerk
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1 Residential
Town Hall, 53095 Main Road
P. 0. Box 1179 t'o.- S . ` :" .`' Non-Residential
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Southold, New York 11971 ® , O ,�
Telephone : I At
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
QACIVE® APPLICATION
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10 in MTh Suthdt OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 7
3-7
Fee
$
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OWNER NAME: bji
OWNER MAILING ADDRESS: ?7S /G-Sl3C-- � kOAT)
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OWNER PROPERTY ADDRESS: <5 /'J
OWNER TELEPHONE NUMBER: Of `"3J I
TAX MAP NO. : 'Section Block Lot
CROSS STREET: � 1),
TYPE OF SYSTEM: Septic Tank V New Existing
Cesspool V New Existing 1/
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: 6-g 6
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.)
a_j_e O I /. 14 /
�� nature of Applicant
L AC394;11/2—
RECEIVED BY:
Town Ck's Of ice
DATE: if/ 77_0_ /, /02 ( �S�
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SHOWN HEREIN ARE FVOM FIELD 0RSERVATI0N$/AN /2,1926 AS FILE NO 80/.
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