HomeMy WebLinkAboutFoehr „s , Town Hall, 53095 Main Road
'� P.O. Box 1179
Vc v•`O° ' ® �r Southold, New York 11971
JUDITH T.TERRY - L�� ,••• TELEPHONE
TOWN CLERK � (516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 833-R Residential X Non-Residential
Fee $ 10. 00 Septic X Cesspool
New Existing X
Name Of Owner FOEHR, CAROL D.
Mailing Address 1 24 THORNHEDGE ROAD
Mailing Address 2
City St Zip BELLPORT NY 11713-0000
Property Address 1 1765 SMITH ROAD
Property Address 2
City St Zip PECONIC NY 11958-0000
Owner Telephone No . 516-286-3809
Tax Map No. section 98. 00 block 4 lot 20 . 000
Cross Street INDIAN NECK ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 9/15/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK cl\FFD(,
Town of Southold Q .- ��G- Application No. C/23
Judith T. Terry, Town Clerk "' y
Town Hall, 53095 Main Road r4-; `` `'r Residential v
P. O. Box 1179 cry .4:',1-t Non-Residential
Southold, New York 11971 O ®`►4-. 0��,,•
Telephone �j `j► '�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 13�
/6 Fee $ '
DATE —IS " CtS"C‘
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OWNER NAME: crar.rO\ -9, fie(
OWNER MAILING ADDRESS: 24-11(1�•rn)(N `
R)Q,\\IcZjNiA, t\ . In i3
OWNER PROPERTY ADDRESS: J 7g S01
C'eca r '(‘\41 '
OWNER TELEPHONE NUMBER: 5/( - 7,156-Y.609
TAX MAP NO. : Section 78 Block Li Lot 0
CROSS STREET: --Ey\G,‘A N(\1GV` \ ,c G\ •
TYPE OF SYSTEM: Septic Tank )C New Existing X
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: r_ _
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.)
• (7 /
ignature of • pplic nt
RECEIVED BY:
RECuVwn Clerk's Office
DATE:
SEP 1 5 1988
Town Clerk Southold
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