HomeMy WebLinkAboutMallgraf (2) OFFICE OF THE TOWN CLERK ' f(j
Town of Southold
Judith T. Terry, Town Clerk „,
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Town n Hall, 53095 Main Road
P. 0. Box 1179 i, ae�`r
Southold, New York 11971 p _:
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Telephone =01
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT •
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 547 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool x
NAME OF OWNER: Robert C. Mallgraf and Phyllis B. Mallgraf
OWNER MAILING ADDRESS: P.O. Box 371
Southold, New York 11971
OWNER PROPERTY ADDRESS: 500 Goose Creek Lane
Southold, New YOrk
OWNER TELEPHONE NUMBER: 516-765-2137
TAX MAP NO. : Section 79 Block 1 Lot 4
CROSS STREET: North Bayview Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
uoolearlf-a •
Judith T. Terry
Southold Town Clerk
DATE: December 22, 1987
(TOWN SEAL) I
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OFFICE OF THE TOWN CLERK 'c�V� FO( r..'
Town of Southold �% �-r- ea -- Application No. 15'7 7
Judith T. Terry, Town Clerk 30,•� . `�
Town Hall, 53095 Main Road o y _" 3 �, Residential
P. O. Box 1179 C°' ? 4 M' s�,' Non-Residential
Southold, New York 11971 O ® fc' ��
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Telephone
-- 4
Telephone `
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.,S1//
od
Fee $ /0'
DATE /.27////g 7
OWNER NAME: Ai®��C � i /'w �s .4 �.��,.�! I//i
OWNER MAILING ADDRESS: (:;`? , 7.4P,- • 7f /
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OWNER PROPERTY ADDRESS : . 4�0 �2 '
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OWNER TELEPHONE NUMBER: 65 Y6----(:- c="2/27
TAX MAP NO. : Section '/ 7 Block Lot 4
CROSS STREET: ,7°'f71- € <J
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ✓ New Existing
Residential ,/ Non-Residential
DATE OF PREVIOUS PUMP-OUT: //.2 2//
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.).
/' - e771,plica a
Signature of Ap
ACPRECEIVED BY: �•S'/ a Ari ,'` /
Town Cl-rk's Office
DATE: /02/A4/17
EIVE
DEC 221997
Inv CO( Southold
ROBERT C. MALLGRA
J—f' - `,;Y P. 0. Box 371
Southold, N.Y., 11971
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