HomeMy WebLinkAboutHaas (3) %c) fie®
.G
rrt; Town Hall, 53095 Main Road
!- ,►� P.O. Box 1179
1 `4, ►� Southold, New York 11971
JUDITH T. TERRY �� �����►►► TELEPHONE
TOWN CLERK (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. 1046-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner HAAS, JOHN J.
Mailing Address 1 P. O. BOX 321
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 ROUTE 48
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-8652
Tax Map No. section 141 .00 block 2 lot 15.000
Cross Street SHIRLEY DRIVE
Date Of Last Pump Out 0/00/00
Issue Date: 3/15/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK. L
ic��FFQ -(x°' , I
Town of Southold �� . 1.4.-- Application No. /61 l 6
Judith T. Terry, Town Clerk .` gy, '' y
Town Hall, 53095 Main Road t4 �'''"' 3-_, :-.4' Residential
P. O. Box 1179 v' ' ='�.;_ :-;y : i ; Non-Residential
Southold, New York 11971 O r �.': $
Telephone 4l *6
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for .
OPERATION PERMIT '
SEPTIC TANK or CESSPOOL
Operation Permit No. b"
Fee $
. DATE 3h3 //
OWNER NAME: JO f At c.). A-A-S
OWNER MAILING ADDRESS: Kr-- 4g ICU, BQ,c3r. J
I ..-1--T7Dc, ,� AV //9
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: Lc/t<— �-e? reCTS--- ,
TAX MAP NO. : Section / V / Block a Lot / -
CROSS STREET: - -4 i
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: c2./ 3 /gq.
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.)
,t41/aLica • , gir ,
/ Signatudir Applicant
RECEIVED BY: , Cu
own Clerk's Office
. DATE: 3 / 3 ZO
•
.-`
RT 41g.
\ v
o0