HomeMy WebLinkAboutHeyliger OFFICE OF THE TOWN CLERK
Town of Southold ���� ��Olj
Judith T. Terry, Town Clerk j�
Town Hall, 53095 Main Road
P. O. Box 1179 �cn • �,'
Southold, New York 11971
Telephone �l ili
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 619 Residential X
Fae $ 10.00 Non-Residential
Septic Cesspool x
NAME OF OWNER: LeRoy J. Heyliger
OWNER MAILING ADDRESS: 1585 Wickham Avenue, Bok.571
Mattituck, New York 11952
OWNER PROPERTY ADDRESS: 1585 Wickham Avenue
Mattituck, New York
OWNER TELEPHONE NUMBER: 516-298-8731
TAX MAP NO. : Section 140 Block 1 Lot 2
CROSS STREET: -North Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT:
•
Aggil
• - - 'Judith T. T ry -
Southold Town Clerk
DATE: February 23, "1988 - -
••- - - ITOWN -SEAL) •
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OFFICE OF THE TOWN CLERK VFFOLA�i' /
Town of Southold �� CQ Application No.
Judith T. Terry, Town Clerk t G :`
53095 Main Road ~ �G Residential
Town Hall, c
CJ's �z
P. O. Box 1179 %.3.c›-
Telephone
= r�: ; Non-Residential
Southold, New York 11971 0N-4%.
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Telephone '.
(516) 765-1801 -
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT -
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ ®r COO
DATE 2) O
-17OWNER NAME: �th, //c/Z7
OWNER MAILING ADDRESS: /5r6- /c&'// ., 4/4- go/ k " C "
/V417710 Z./. /12 //f51X.
J
OWNER PROPERTY ADDRESS:: - ,11,4j-- AS
/ -
OWNER TELEPHONE NUMBER: ...c/o r- f-7 3
TAX MAP NO. : Section ( (7 70 Block ( Lot
CROSS STREET: U/ K,Z/ A 11E,
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: UN l f?
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.)
.40
r• ignat re Applicant
RECEIVED BY:r> dr.
own erk's Off ce
DATE: *2..3/a/ -
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