HomeMy WebLinkAboutKlein OFFICE OF THE TOWN CLERK w• �J����[�I`L'
Town of Southold
Judith T. Terry, Town Clerk 4 '1a
Town Hall, 53095 Main Road �2 K•�` �
P. O. Box 1179 tri et't f r,
Southold, New York 11971 `ti p ► ` .: " �- 1
Telephone :''?i 4( 1P
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 332: Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool x
NAME. OF OWNER: James H. and Doris J. Klein
OWNER MAILING ADDRESS: 410 Woodcliff Drive
Mattituck, New York 11952
OWNER PROPERTY ADDRESS: 410 Woodcliff Drive
Mattituck, New YOrk
OWNER TELEPHONE NUMBER: 516-298-8805
TAX MAP NO. : Section 107 Block 8 Lot 14 _
CROSS STREET: Brower Road
TYPE OF SYSTEM: Septic Tank New Existing -
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: May 10. 1987
Judith T. Terry
Southold Town Clerk •
DATE: . July 15, 1987
- (TOWN SEAL)
OAP
OFFICE OF THE TOWN CLERK 2
JCQG Application No.
Town of Southold � U oZ,
Judith T. Terry, Town Clerk to bit 44.
Town Hall, 53095 Main Road
Residential ��
P. O. Box 1179 u' �; ' �' Non-Residential
Southold, New York 11971 11971NcZttl.4, �0�
Telephone 1
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /04 00
DATE 7/a/87
OWNER NAME: ]0j141es H J.
OWNER MAILING ADDRESS: V/Q vobaicv 2:)ri ✓ E
Nc, tZ , e V ?
OWNER PROPERTY ADDRESS: S0441P a S 4 t o ✓e
OWNER TELEPHONE NUMBER: Sf 4 2 ? 8 88 Os-
TAX
sTAX MAP NO. : Section /0 7 Block o $ Lot /51
CROSS STREET: 73 L,vwev RC)aa/
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool a. New Existing ./,
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: /0) S
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.)
Qr524-2-0 JaA-A-;‘,
Signature of Applicant
- V
RECEIVED BY:
Town Clerk's Office
DATE:
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BROWER ROAD
SURVEY FOR
JA MES H. KLEIN & DORIS J. KL EI N
AT MATTITUCK
TOWN OF SOUTHOLD
SUFFOLK COUNTY, N. Y.
1000- 107- 08 - 14
SCALE : 111= 301
SEPT 25, 1986
SEPT 26, 4986
CERTIFIED TO
SOUTHOLD SAVINGS BANK
JAMES H. KLEIN
DORIS J. KLEIN
`ANDS'. Prepared in accordance with the minimum
0 TUR`' standards for title surveys as established by
1. MB
40 O,j,� a 2C� Fl the L.I.A.L.S. and aPProved and adopted
_V ,i 11 la for such use by The New York State Land
-1j�` Title Association.
i" N.Y.S LIC. NO.49618
• PECONIC SURVEYORS A ENGINEERS, P C.
(516) 765 -5020
P. O. BOX 909
MAIN ROAD
1 SOUTHOLD,N.Y. 11971
86-515