HomeMy WebLinkAboutHabermann 404Z '
Town Hall, 53095 Main Road
r P.O. Box 1179
s�� Southold, New York 11971
JUDITH T.TERRY =®`� �' TELEPHONE
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TOWN CLERK (516) 765-1801
REGISTRAR 01 VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 636-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner HABERMANN, MATILDA
Mailing Address 1 2505 CAMP MINEOLA ROAD
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 2505 CAMP MINEOLA ROAD
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-8778
Tax Map No. section 123 .00 block 6 lot 8. 000
Cross Street ALOIS LANE
Date Of Last Pump Out 0/00/00
Issue Date: 3/04/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK 0cuFF0(.,r "=
Town of Southold a_Application No34
Judith T. Terry, Town Clerk Residential
Town Hall, 53095 Main Road
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P. O. Box 1179 cn '? >� .= T► .` Non-Residential
Southold, New York 11971 O
Telephone '44
(516) 765-1801 =01 •0;9
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
- - for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /O --
DATE /-23-88 (, �co 207 ta.�
OWNER NAME: /ix,TiLU4 /<-04.Q,672/ 4,viV
OWNER MAILING ADDRESS: 25-06 /l7,,v i..,q OAA
Al.eirT/rue1C, Ay /196-2
OWNER PROPERTY ADDRESS: 4A1E
OWNER TELEPHONE NUMBER: 290 — 8778
TAX MAP NO. : Section /23 Block 6 Lot 8
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential x Non-Residential
DATE OF PREVIOUS PUMP-OUT: �pz,q.,.�� Aaeur 3- 9)/ears q0
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.)
Sig ure of Appli t
4111j- r
RECEIVED BY: or ae�
Town iClerk's ffice
DATE: 7'1ce2,di `f . i 9 erid