HomeMy WebLinkAboutKiefer OFFICE OF THE TOWN CLERK
Town of Southold , 4�
Judith T. Terry, Town Clerk .ti ..� �' °V e
Town Hall, 53095 Main Road e;r
P. 0. Box 1179 �r
Southold, New York 11971 ^Q �� �- J
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 150 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool X
NAME OF OWNER: Walter and Shirley Kiefer
OWNER MAILING ADDRESS: 152 Hackett Place
Rutherford. New Jersey 07070
OWNER PROPERTY ADDRESS: 4285 Bayshore Road
Greenport. New York
OWNER TELEPHONE NUMBER: 201-939-0484 516-477-0524
TAX MAP NO. : Section 53 Block 6 Lot 6
CROSS STREET: Kerwin Blvd. {So. of RotitP 75) _
TYPE OF SYSTEM: Septic Tank x New Existing x
Cesspool x New Existing x
Residential x Non-Residential
DATE OF PREVIOUS PUMP-OUT: 2' • : , .
Judith T. Terr
Southold Towri Clerk
DATE: November 17, 1986
(TOWN SEAL) -
90
OFFICE OF THE TOWN CLERK COFOU
Town of Southold �� L App Application No. /-3-0
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road c -_.,,M,, :G Residential
P. O. Box 1179 crs = �' Non-Residential
•• Southold, New York 11971 O"-.� �^ <��'
0 ���-o
Telephone _ j y
(516) 765-1801
TOWN OF SOUTHOLD
RECEIVED
SEP 081986 SOUTHOLD WASTEWATER DISPOSAL DISTRICT
m n Ct&rk Southold APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL -
Operation Permit No. /5
Fee $
DATE 9 -- 2' C
OWNER NAME: 4,0 AL:r l lz( �� 1
OWNER MAILING ADDRESS: ( 5a ActLe- r Ca C..�
u `t 14 L r2AM LY? 07-o
OWNER PROPERTY ADDRESS: .3 5
OWNER TELEPHONE NUMBER: ( L4 '?3 1 l,cfl - sl(d 4-7) os724_
TAX MAP NO. : Section _(.9 -3 Block 06 Lot cod,
CROSS STREET: Ke uic x(10 So oF-
TYPE OF SYSTEM: Septic Tank `( New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: j �f` �. / 4 fr
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.)
4
Sig ature o
RECEIVED BY: (�y)r d_a_
RECEIVED C rk's fice
DATE: -
Town Clerk Southold
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