HomeMy WebLinkAboutHaerr OFFICE OF THE TOWN CLERKFQ Cx(j
Town of Southold ��F =
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road
P. O. Box 1179 1%L � $`
Southold, New York 11971
- Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL •
Operation Permit No. 496 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool x
NAME OF OWNER: Mr. and Mrs. Karl A, Haerr
OWNER MAILING ADDRESS: 20 Hillcrest Avenue
Port Jefferson, New York 11777
OWNER PROPERTY ADDRESS: 305 Mill Creek Drive
Southold. New York 11971
OWNER TELEPHONE NUMBER: 516-473-1668
TAX MAP NO. : Section 135 Block 3 Lot 2R_ 1
CROSS STREET: Grove Drive
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool x New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
Y
Southold Town Clerk
DATE: November 24, 1987 -
(TOWN SEAL)
. ,,,
OFFICE OF THE TOWN CLERK ���FFO
Town of Southold ®�: 1.:: . Application No. -%
Judith T. Terry, Town Clerk % .. ''•
Town Hall, 53095 Main Road ""' .. s;` '� Residential
P. O. Box 1179 crs ' * ' ` Non-Residential
Southold, New York 11971 O ® F �`
Telephone 410 I
(516) . 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.4-0
Fee $ `v —
DATE 1f ab R.
OWNER NAME: CZ , VVN-Ctx- iii-
OWNER MAILING ADDRESS: LLQ — �‘ `E,-p.L��
v \-:loN1 W9 ) I).13?
OWNER PROPERTY ADDRESS: 0 . iA_Lcz-te- 2-1L tt yoZ__
OWNER TELEPHONE NUMBER: Sl \z— \i'l -- \\ci \p
TAX MAP NO. : Section / 35- Block 3 Lot (.0
e /
CROSS STREET: 6---2.0\06,.... /L
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing e-----
Residential C� Non-Residential
DATE OF PREVIOUS PUMP-OUT: at. 1e,N o Nq
LOCATION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow and feet
0 \3�� of distance, approximately, to building and closest road.)
L .}
vv..._ ....__ _c.A_,- .r......,,___
Signature of Applicant
RECEIVED BY: C -?�-/VL,g,_
� own k's Of ce
��E
REC
DATE: r. '4'
Imo CIM1( Southold
� 4
r�
W
v
- � r: