HomeMy WebLinkAboutLohn OFFICE OF THE TOWN CLERK • `OfgUr`,D
Town of Southold ®
Judith T. Terry, Town Clerk % Sr
Town Hall, 53095 Main Road . r , � `"f'c
ity
P. 0. Box 1179 v' " '�
Southold, New York 11971 •p®
Telephone ! _ ®d461 �►
(516) 765-1801 ' 1
a TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT •
SEPTIC TANK or CESSPOOL
Operation Permit. No. 219 Residential X
Non-Residential
Fee $ 10.00 '
Septic Cesspool x
NAME OF OWNER: PatricW:W. Lohn
OWNER MAILING ADDRESS: RD 3, Box 250
Southold, New York 11971
OWNER PROPERTY ADDRESS: 2335 Minnehaha Blvd.
Southold, New York
OWNER TELEPHONE NUMBER: 516-765-2286
TAX MAP NO. : Section 87 Block 3 Lot zg X5`5/
CROSS STREET: Wabun R.O.W. and Opechee Avenue
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: November 1986
,01K004;:;el,willememOddoilawarra,
Judith T. Terry
Southold Town Clerk
DATE: February 11 , 1987
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK cvFFO(,t-
Town of Southold �� CSG Application No. 02/?
Judith T. Terry, Town Clerk �� �,; �' Residential
Town Hall, 53095 Main Road• ,
P. O. Box 1179 U' i ;' Non-Residential
if
Southold, New York 11971 O�A� ` ' 0 ��'
Telephone _ f
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. o2 / '
Fee $ /006
DATE 02,11A7
A7
OWNER NAME: 4-Fai G1C L4 D V
OWNER MAILING ADDRESS: ?b 3 60X c 5
(5-0 ( T 4 J
l
OWNER PROPERTY ADDRESS: ca3 3 5 pm iii/A/644-44 BLVD
L1 1D
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OWNER TELEPHONE NUMBER: -766---g0-26
TAX MAP NO. : Section � � Block .3 Lot "L3
CROSS STREET: 6c_.) fi6L/A.i / 0c�� `¢ 07)4-6/11E; 741-/-16-
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: 0O081/Killy)✓ 19ZS 6,
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.)
Si natu��� A p icant
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RECEIVED BY: e_v}�ce,c� .
Town CI rk's Off'ce
DATE:
FEB 1 ® 1981
Town C'.erk Southold
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