HomeMy WebLinkAboutKiefer (2) OFFICE OF THE TOWN .CLER'K I c.OFOLi
Town of Southold �.��
Judith T. Terry, Town Clerk Z '� ''' : e
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Town Hall 53095 Main Road
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P. O. Box 1179 �, v' ' RTE-g- ��
Southold, New York 11971 ,,\•\ `Y � f'' �
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Telephone 0( [
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 504 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: Walter F. and Shirley Kiefer
OWNER MAILING ADDRESS: 152 Hackett Place
Rutherford, New Jersey 07070
OWNER PROPERTY ADDRESS: 3550 Bayshore Road
Greenport, New York
OWNER TELEPHONE NUMBER: 201-939-0484
TAX MAP NO. : Section 53 - Block 6 Lot 37.1
CROSS STREET: Island View Lane _
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existi�
p 9 x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: 1986
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Southold Town Jerk
DATE: December 1, 1-987
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK PFFD
Town of Southold \®� CQ� Application No. 6-0 y
Judith T. Terry, Town Clerk . ,`.;�- ' `, -
-- ; s . 4 1i Residential
Town Hall, 53095 Main Road ,, a. 1
P. 0. Box 1179 cn 144:-C . Non-Residential
Southold, New York 11971 ® " • -,`,
Telephone : .(
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERAT ION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. SD
Fee $ 1 ® d
DATE A/oy. 23 /9 8 7
OWNER NAME: W 4-G re 2 �. SaV/aLEy' / ci ci
OWNER MAILING ADDRESS: '/j , 4C j�j' Re...9c...45
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OWNER PROPERTY ADDRESS: S5(.? 54Ysf/26' Bo
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OWNER TELEPHONE NUMBER: go/ 93 9 ®4•Sa0
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TAX MAP NO. : Section DS3 Block 4 Lot
CROSS STREET: /564,.J ( 'eek) t 4iiff
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing k
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: SePT v2 ®C-%, /9067
LOCATION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow and f et
of distance, approximately, to building and closest road.)
GO 61)(b/‘ ‘ ` . a
Signature of pplitnt
RECEIVED BY: ,,,..
NECENTOwn Ck rk's Offi e
DATE:
DEC 0I NV
lawn Tek Southold
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