HomeMy WebLinkAboutSt Peters Lutheran Church OFFICE OF THE TOWN CLERK • ic,OFO(�t(��
Town of Southold �
Judith T. Terry, Town Clerk Z . :�
Town Hall, 53095 Main Road
P. O. Box1179 ' `l ® t ��`•
•
Southold, New York 11971 O t4 �0�-
Telephone 01 '�
(516) 765-1801
TOWN OF SOUTHOLD
- SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. NR51 Residential
Non-Residential X
Fee $ 25.00
Septic Cesspool X
NAME OF OWNER: St. Peter's Lutheran Church Attn: Harry Fisk
OWNER MAILING ADDRESS: MainFRoad
Greenport, New York 11944
OWNER PROPERTY ADDRESS: Main Road
Greenport, New York -
OWNER TELEPHONE NUMBER: 516-477-0662 - - -
TAX MAP NO. : Section 45 Block 2 Lot 7.1
CROSS STREET: - Chapel Lane
TYPE OF SYSTEM: Septic Tank New Existing T
Cesspool X New Existing X
Residential Non-Residential X
DATE OF PREVIOUS PUMP-OUT: June 15, 1987 - Usually pumped twice each year.
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Southold Town Clerk
DATE: September 10, 1987 -
(TOWN SEAL)
i - S..
OFFICE OF THE TOWN CLERK COMA A' -
Town of Southold ' Application No.�/�
�� �/
Judith T. Terry, Town Clerk . ,�
Town Hall, 53095 Main Road o ._- Residential
P. O. Box 1179 LT-3 ;, z Non-Residential
Southold, New York 11971 _ Y0,0
Telephone .(�
(516) 765-1801
TOWN OF SOUTHOLD •
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.4Y,C Sj ,/
Fee $ O? J
DATE
OWNER NAME: � ���i�,s 2_ Ute// fi,9 ,/ ,t o1'G
OWNER MAILING ADDRESS: /1/,.17/ / RPA
19-7-17 " f f -2cl Fi-ci ,-rf /a/,Po l?T /I/)/- J/l 4/*
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: 7- p Z
TAX MAP NO. : Section 27/5—
Block 02 Lot ' /
CROSS STREET: e/—fp PCL LA-A 1 e_
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: J UA -4 /r/ /ff7—
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.)
-% ‘ /LA
Signature Applicant
RECEIVED BY( eC`_ -
Town Jerk's Ofifice
DATE: 9- 7(.2 - F7
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