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HomeMy WebLinkAboutHerbert OFFICE OF THE TOWN CLERK ' ' Fo Town of Southold Q�� " c Judith T. Terry, Town Clerk 1* 3 o k.k ' Town Hall, 53095 Main Road P. O. Box 1179 Southold, New York 11971 p ®r;`""' 0�. •� Telephone (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 426 Residential X Fee $ 10.00 - Non-Residential Septic Cesspool X • - NAME OF OWNER: Mr. Michael Z. Herbert OWNER MAILING ADDRESS: 795 Pike Street Mattituck, New York 11952 OWNER PROPERTY ADDRESS: 795 Pike Street Mattituck, New York OWNER TELEPHONE NUMBER: 516-298-8785 TAX MAP NO. : Section 140 Block 2 Lot 23 CROSS STREET: Love Lane and Wickham Avenue TYPE OF SYSTEM: Septic Tank New Existing Cesspool X New Existing X Residential X Non-Residential DATE OF PREVIOUS PUMP-OUT: Approx. April 1986 u!!th T, Terry Southold Town Clerk DATE: September 16, 1987 (TOWN SEAL) \ • OFFICE OF THE TOWN CLERK cvFFDU( Town of Southold Application No. � Judith T. Terry, Town Clerk Town Hall, 53095 Main Road ,3.,. � Residential P. 0. Box 1179 c.r3z• Non-Residential Southold, New York 11971 Telephone : .( 1114 (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION nut_ OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 142-6 Fee $ 1 f} ,fl fl DATE September 15, 1987 • OWNER NAME: Mrn Mi rhaPl HPr1 ert OWNER MAILING ADDRESS: 795 Pike Street Mattituck, 7N.Y. 11952 OWNER PROPERTY ADDRESS: (same) OWNER TELEPHONE NUMBER: 516-298-8785 TAX MAP NO. : Section 140 Block 2 Lot 23 CROSS STREET: Love Lane & Wicham Avenue TYPE OF SYSTEM: Septic Tank New Existing Cesspool x**** New Existing Residential ******* Non-Residential 40,-E OF PREVIOUS PUMP-OUT: July 22, 1987 - � ,Lp' $6 �� LOC • I.N MAP• Must be attached hereto before permit may be issued. iiiiarmArtNINIIIMEgar (Locate building and system; give north arrow and feet „� ;;.n �' of distance, approximately, to building and closest road.) 5 „, j= S° (3 5poo/5 zrSigna re of Applican �\C4 17 CLEC RECEIVED BY: o'&4(_-6( Town Cle 's Offi eji-j RECEIVED DATE:_se°t _ _ Town CDerk Southold