HomeMy WebLinkAboutLappe OFFICE OF THE TOWN CLERK ' ' •S�FFDC(
Town of SoutholdCOG
Judith T. Terry, Town Clerk _ _ �
Town Hall, 53095 Main Road a `W
P. O. Box 1179
Southold, New York 11971 • ',,
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 53 Residential XX
Fee $ 10.00 Non-Residential
Septic Cesspool XX
NAME OF OWNER: Frederick Lappe-
OWNER MAILING ADDRESS: 2290 South Harbor Road
Southold, New York 11971
OWNER=PROPERTY.-ADDRESS-: - 22.90=-South-Harbor_Road
)
Southold. New York
OWNER TELEPHONE NUMBER: 516-765-3746
TAX MAP NO. : Section 75 Block 7 Lot 2
CROSS STREET: Ba ywater
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool XX New . Existing XX
Residential XX Non-Residential
DATE OF PREVIOUS PUMP-OUT: August 6. 1984
4001446119.0.":11 .04110r
Judith T. Terr
Southold Town Clerk
DATE: September 19, 1986
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK �S1FOU( 1414,
Town of Southold � CQt� Application No.
Judith T. Terry, Town Clerk �` ,: y: .
Town Hall, 53095 Main Road g :< Residential
P. O. Box 1179 to Non-Residential
Southold, New York 11971 O' O�•1`
Telephone 01
(516) 765-1801 - e
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. L-73
Fee $ `c'
DATE O S Q�p
OWNER NAME: FRE-p4----/ jpp,�`
OWNER MAILING ADDRESS: ,Z2 f0 $Oc rik_ «/9/e& de A
OWNER PROPERTY ADDRESS: ? SF
OWNER TELEPHONE NUMBER:
TAX MAP NO. : Section /7,", Block 7 Lot •%f
CROSS STREET: /34 )/447- --g,,
TYPE
44- --
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: g
LOCATION MAP: Must be attached here o before permit may be issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
1.1" /
Signatu of A.pI f`f
•
RECEIVED BY:
Town Clerk's Office
DATE:
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