HomeMy WebLinkAboutHofmann ``� Town Hall, 53095 Main Road
al) �� P.O. Box 1179
® i� 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. 853-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner HOFMANN, GEORGE J. & MARILYN Q
Mailing Address 1 P. O. BOX 452
Mailing Address 2
City St Zip PECONIC NY 11958-0000
Property Address 1 HUNTINGTON BLVD
Property Address 2
City St Zip PECONIC NY 11958-0000
Owner Telephone No. 516-765-2897
Tax Map No. section 67. 00 block 2 lot 21. 001
Cross Street SALT MARSH LANE
Date Of Last Pump Out 7/00/85
Issue Date: 9/22/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
•
OFFICE OF THE TOWN CLERK COFO (,(� '- _
Town of Southold CApplication
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road � ,�, ""4. Residential
.�
P. O. Box 1179 cry -gym Non-Residential
Southold, New York 11971 0Q;`_>00,04.
Telephone �(
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
•
Operation Permit No.
Fee $ /D• °--o
DATE S= aD, /fit
• OWNER NAME: /fdrApi.4N,ifQ. wi,cc)
OWNER MAILING ADDRESS: P.O. eel 44r2.
f
/c7cot/c. 4/V //9.573
OWNER PROPERTY ADDRESS: ,yr-/,i(G-Tam
)iC?, //v //9168
OWNER TELEPHONE NUMBER: . 76-
n �c�eC,cd co dvry 67. - / wow,✓e 4g3G Agra ash
TAX MAP NO. : Section Block ..54,44&-S Lot ,herr / r--
CROSS STREET: S447- /LIazz Lait/ '
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing !/
Residential V Non-Residential
DATE OF PREVIOUS PUMP-OUT: tVtJLr Z9.5r
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.)
Si ture of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
-
'v
SOUND Aqe„.
Got f2- ( LOT i3
ExcsrrNG-
a • 'CO- S e091-45
W" 15' cow\ 4100sS
5A LT MAQS 4 I.AA)
2
Lor 36 I LOT 3SI
f
se_cooD p‘va•