HomeMy WebLinkAboutLang OFFICE OF THE TOWN CLERK ��
Town of Southold ^~
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road ' tea '= H eV
P. O. Box 1179 ' cn
Southold, New York 11971
Telephone qfo/ INV
(516) 765-1801 rrfi
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 581 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool X
NAME OF OWNER: Gerard M. and Marilyn K. Lang
OWNER MAILING ADDRESS: P.O. Box 183
Peconic, New York 11958
OWNER PROPERTY ADDRESS: Cedar Point Drive West, Cedar Beach Park
Southold, New York 11971
OWNER TELEPHONE NUMBER: 516-765-1096
TAX MAP NO. : Section 90 Block 1 Lot
CROSS STREET: Little Peconic Bay Lane and Midway Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: May 1987
OP, v7 ?
Judith T. T; y
Southold Town Clerk
DATE: January 26_ 1988
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK .0��Fp(�.��=
Town of Southold , Application No. (5-. 1
Judith T. Terry, Town Clerk y .14,,A141‘1 Residential
Town Hall, 53095 Main Road x
P. O. " Box 1179 cnO
� �` Non-Residential
Southold, New York 11971 5 ?i
�0�,�•i
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /a. 00
DATE 1 f3 ✓t) t � 1988
OWNER NAME: GE,q,q,eo , Sp MARILi et) 6(. 14 A NG-
OWNER MAILING ADDRESS: Po. 12 OX 18 3
PEV MN/ /i Qs 8
OWNER PROPERTY ADDRESS: SA c -.o / ?ib'v Akoi VE was
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OWNER TELEPHONE NUMBER: 74-s--- Je, 96
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TAX MAP NO. : Section 90 Block / Lot
CROSS STREET: 1.,—TLEria-ca„,, shy/ kA 46.1 Mit)W,4y rho.
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
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Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: /7141/ eSS7
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.)
Signat re of Aplicant
RECEIVED BY:
Town Clerk's Office
DATE:
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