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OFFICE OF THE TOWN CLERK • c31 HU( _
Town of Southold �
Judith T. Terry, Town Clerk
*
Town Hall, 53095 Main Road s��.
P. O. Box 1179cn _ u
Southold, New York 11971 O 0�•�,
Telephone Ttl 4 ��
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 311 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool X
NAME OF OWNER: Charles L. Lauer
OWNER MAILING ADDRESS: Box 2883, Friends Road
Setauket, New York 11733
OWNER PROPERTY ADDRESS: 895 Greenfields Lane
Southold, New York
OWNER TELEPHONE NUMBER: 516-751-1489
TAX MAP NO. : Section 63 Block 1 Lot 31
• CROSS, STREET: Barley- Lane
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New X Existing
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: N/A
Judith T. Terni
Southold Town Clerk
DATE: June 23, 1987
(TOWN -SEAL)
.. ..i
OFFICE OF THE TOWN CLERK �COFDCr....=
' Town of Southold �O -;:- _. CQ�', Application No.c...3 )1
Judith T. Terry, Town Clerk % t /
Town Hall, 53095 Main Road �v:- -, -G 7 Residential 17--
Town
/
P. O. Box 1179 5' .a g z Non-Residential
4
Southold, New York 11971 O .-, , 0\"„ ��`
Telephone e./ °�� 'e•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. '3/7
Fee $ .) a
DATE e `'./7
OWNER NAME: C...-4 C.(vie.c L 1 L CI CIc:'
OWNER MAILING ADDRESS: a, -,_as.,-,... -f—rt'e44 acts at
__Vri..e..L. 11-1-.--11-„, W \/ 11733
OWNER PROPERTY ADDRESS: P74---
,---4,- .si `�./Cic ,Q!_iV
SOU_Pgofdi, W , / / qv
OWNER TELEPHONE NUMBER: . /(p — TV— /4E1 •
j TAX MAP NO. : Section /05 Block / Lot J /
CROSS STREET: Laarley 40�`1/4-e °
TYPE OF SYSTEM: Septic Tankew fes"- Existing _
Cesspool L— New L- Existing
Residential 1_,------ Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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.)
. P7..4ict.t.),(3)0/i4..61.,
Signature of Applicant
W.
RECEIVED BY: (d ` a
'Fown Clerk Office
DATE: 4/7_77(767
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