HomeMy WebLinkAboutZeller OFFICE OF THE TOWN CLERK ' %IRV(
Town of Southold ,t " % -
Judith
T. Terry, Town Clerk
Town Hall, 53095 Main Road 8 -
P. O. Box 1179 •stn
Southold, New York 11971 ;O
Telephone -:4°1 *
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. NR 9 Residential
Fee $ 25.00 Non-Residential XX
Septic Cesspool XX
NAME OF OWNER: Patricia Zeller
OWNER MAILING ADDRESS: Route 25
Greenport, New York 11944
OWNER-PROPERTY-ADDRESS: -Rou-te. -25 .(-Drossos -Restaurant)
Greenport, New York
OWNER TELEPHONE NUMBER: 516-477-2155
TAX MAP NO. : Section 45 = Block 1 Lot 12
CROSS STREET: Chapel Lane
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool XX New Existing XX
Residential Non-Residential XX
DATE OF PREVIOUS PUMP-OUT: August 1986
•
Judith T. Ter
Southold Town Clerk
DATE: September 19, 1986
(TOWN SEAL)
OFFICE OF THE TOWN CLERK /IFQ �//
Or
Town of Southold OHO 4 . Application�l�9o.
Judith T. Terry, Town Clerk �`�
Town Hall, 53095 Main Road ` 'G Residential
P. 0. Box 1179 cn ,+ � �.` Non-Residential
Southold, New York 11971 `�O ` •�`
Telephone _�l s�® '�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE
OWNER NAME: D /f6,3.55
OWNER MAILING ADDRESS: / -7^ 5--
OWNER
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: K---77
TAX MAP NO. : Section /-7L/ Block / Lot / �
CROSS STREET: / '41 /
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool v"— New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT:
(f-'1‘
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.)
Signature of Ap , isant
RECEIVED BY: (4t_cpc� ( )
Town Cle 's Offide
DATE: )2,tptiz_4rx Q0i 9 (