HomeMy WebLinkAboutLademan JUDITH T. TERRY
Town Hall, 53095 Main Road
TOWN CLERK ` P.O. Box 1179
REGISTRAR OF VITAL STATISTICS _ Southold, New York 11971
`.
MARRIAGE OFFICER O �. Fax (516) 765-1823
/ � Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1971-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner LADEMANN, CHARLOTTE M.
Mailing Address 1 1505 PARK WAY
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 1505 PARK WAY
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-2247
Tax Map No. section 70.00 block 11 lot 17.000
Cross Street WOOD END WAY
Date Of Last Pump Out 0/00/00
Issue Date: 9/21/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK .0
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Town of Southold �C ,. Application No. /�
Judith T. Terry, Town Clerk �` a �►�
Town Hall, 53095 Main Road ' $10.00 - Residential
P. 0. Box 1179 cn =' ' `
4 r � $25.00 - Non-Residential
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Southold, New York 11971 O ® .3•x, . O� ��`
Telephone Q( 0),
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ / r?e 0 0
DATE September 21 , 1992
Sept
OWNER NAME: Charlotte M;, Lademann
OWNER MAILING ADDRESS: 1505 Park Way, Southold, N.Y.
OWNER PROPERTY ADDRESS: 1505 Park Way--
Southold,
aySouthold, New York
OWNER TELEPHONE NUMBER: 516®765-2247
TAX MAP NO. : Section 70, Block 11 Lot 17
-CROSS STREET: Wood End Way
TYPE OF_ SYSTEM: Septic Tank x New Existing x
Cesspool 2 New Existing x
Residential x Non-Residential -'
DATE OF PREVIOUS PUMP-OUT: None
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.)
Signature of Applicant
RECEIVED-BY:
Town Clerk's Office
DATE:
•
_
Charlotte M, Lademann
- Septic Tank & Cesspool Location
1505 Park Wav, Southold, N.Y-
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