HomeMy WebLinkAboutFishman OFFICE OF THE TOWN CLERK • c0FOUroix
Town of Southold �
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road
P. O. Box 1179
Southold, New York 11971 `Q ® •
•0�••,
Telephoneefts
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 141 Residential x
Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: Harold Fishman
OWNER MAILING ADDRESS: 255 BreidstacLt Court
Southold. New York 11971
OWNER PROPERTY ADDRESS: 255 Breidstadt Court
Southold. New YOrk
OWNER TELEPHONE NUMBER: 516-765-5768
TAX MAP NO. : "Section 70 Block g Lot 24
CROSS STREET: Custer Avenue
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
otrameaV
Judith T. Terry
Southold Town Clerk
•
DATE: November 13, 1986
(TOWN SEAL) •
OFFICE OF THE TOWN CLERK J
Town of Southold � CQ Application No. /`/7 /
Town Clerk
Judith T. Terry, Off' a T�
� � �
Town Hall, 53095 Main Road �. Residential hr
P. O. Box 1179 u-) Non-Residential
Southold, New -York 11971 •S
Telephone
o �,o • •
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. /1-/ /
Fee $ on
DATE Nov`2CYtP'Vo
OWNER NAME: kin yz,I c] shtry,o n
OWNER MAILING ADDRESS: a55 &r-eJ S -ri c
)-u.141A U l ley I l g-1-1
OWNER PROPERTY ADDRESS: (sc h .)
OWNER TELEPHONE NUMBER: 7/n5_ 57(42
TAX MAP NO. : Section /0 Block Lot pi-,
CROSS STREET: el���ii>�_
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential / Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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.)
Signat a of Applicant
RECEIVED BY: c,
Town Clierle
DATE: Y7r-61-c-cJ
- .
Unauthorized alteratirxi or add' '
—, : to this sunray is a violation of ' - , .
INKYS.51-10vIN REF-ELL.TC) "NIP OF
- I . , --- . , -, •,-..: -', Section 7209 of the New York S -
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SM I TEA Fr ELL) PA12.V. " ON FILE IN r -,---
• . C0011511 of thIS survey map not be ng
50 aiS-TER_ Avc- _‘..,: the land surveyor's Inked seal or .
T1-1E. '5U Ftr-sCi LV COUNTY CL E.Q1-175
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-• -; embossed seal shall not be considered ,
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Guarantees indicated hereon shall run
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.•.,_ titie.comoff,governmental egency and
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to the assignees of the lending insti-
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