HomeMy WebLinkAboutHascoat OFFICE OF THE TOWN CLERK + oG _
Town of Southold
Judith T. Terry, Town Clerk , Sb.
Town Hall, 53095 Main Road
P. O. Box 1179 r �
Southold, New York 11971 O
Telephone ' ..( t
(516) 765-1801
TOWN OF SOUTHOLD _
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. NR 22 Residential
Non-Residential x
Fee $ 25.00
Septic Cesspool x
NAME OF OWNER: Robert Hascoat - LaGGazelle
OWNER MAILING ADDRESS: Main Road
Southold, New York 11971
OWNER PROPERTY ADDRESS: Main Road
Southold, New York
OWNER TELEPHONE NUMBER: 516-765-2656
LS-
TAX MAP NO. : Section 63 Block 3 Lot 20
CROSS STREET: Town Harbor Lane
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential Non-Residential x
DATE OF PREVIOUS PUMP-OUT: September 1986
Judith T. Terr,/'
Southold Town Clerk
DATE: November 3, 1986
(TOWN SEAL)
•
OFFICE OF THETOWN CLERK cl\V O
Town of Southold �� r CDG', Application No.
Judith T. Terry, Town Clerk = �`� Residential
Town Hall, 53095 Main Road 8 ; f
P. O. Box 1179 cn •, r. Non-Residential
Southold, New York 11971 ��`
Telephone :0.( �.
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
RECEIVED
APPLICATION
NOV :6 •
a for
Town Clerk Southold -
• OPERATION PERMIT •
SEPTIC TANK or,CESSPOOL
Operation Permit N o./l/e
Fee $ • -
DATE /I• lo
jre .+�i (
OWNER NAME: gar ,A1566/cm' <'� ���� 1
OWNER MAILING ADDRESS: vri�,{
,4ary-d
PROPERTY,ADDRESS: kat '=
OWNER TELEPHONE NUMBER:
TAX MAP NO. : Section; ,(7 ,3 Block J Lot O o2/ 02
CROSS STREET: ��w , FILM 6,0 4_,TA)
TYPE OF SYSTEM: Septic Tank New Existing
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p
Cess ool New V Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: 4 11,I, j1i 1 I �
LOCATION MAP: Must be attached hereto be'•re permit may be issued.
(Locate building and sistem; give north arrow and feet
of distance, approximately, to building and closest road.)
/a u
Signature o Ap licant •
RECEIVED BY: c--2.c—
Town C1Xerk's ffice
DATE: . YL(g-t). 3 . / 9 eiG
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