HomeMy WebLinkAboutLangelier OFFICE OF THE TOWN CLERK- • FO
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Town of Southold OQ�� , �C�G
Judith T. Terry,' Town Clerk • Z r * ;`-� { �
Town Hall, 53095 Main Road
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P. O. Box 1179 �, Y
Southold, New York 11971 \`p'�i'
Telephone - _ ®ja
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
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SEPTIC TANK or CESSPOOL
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Operation Permit No. 462 - Residential x
Non-Residential
Fee $ 10.00
Septic Cesspool x
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NAME OF OWNER: Gerald J. Langelier
OWNER MAILING ADDRESS: 70-01 Kessel Street
Forest Hills, New York 11375
OWNER PROPERTY ADDRESS: 375 Soundview Avenue Ext.
Southold, New York 11971
OWNER TELEPHONE NUMBER:- 516-765-1168
TAX MAP NO. : Section 50 Block 2 Lot fi
CROSS STREET: Lighthouse Road
TYPE, OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
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DATE OF PREVIOUS PUMP-OUT: Unknown
Judith 1 . Z er ry
Southold Town Clerk
DATE: October 14, 1987
(TOWN SEAL) \,i
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OFFICE OF THE TOWN CLERK 'c�VFFD(,��
Town of Southold �o �QG Application No. 1�
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road c •
S : Residential
p. O. Box 1179 cr1 Non-Residential
Southold, New York 11971 a *-et`�
Telephone ( y
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 2/6
Fee $ od
DATE
OWNER NAME: r-eRni-D xi • kimicCPJTic
OWNER MAILING ADDRESS: 7p- D/ /rocs _ r
/Fs-r- h /)-i-s N ( 113
OWNER PROPERTY ADDRESS: X75 sCr�u Nt, t/1 Ew /9-✓5-- EXT,
SC)UTff , liq71
OWNER TELEPHONE NUMBER: 0/6 - 76 1 16 1
TAX MAP NO. : Section (___5-6 Block Lot ;6
CROSS STREET: ot4a4_444-z ,ad.
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool V New Existing
Residential V- Non-Residential
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DATE OF PREVIOUS PUMP-OUT: ccg /
JI ,-L /RAFJ6 A- c� �� 1 lief]
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.)
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Signature of Applicant-
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RECEIVED BY:
mow Town( rk' ce
DATE: off 14 199
Town Clerk Southold