HomeMy WebLinkAboutGloeckler OFFICE OF THE TOWN CLERK FO
Town of Southold
Judith T. Terry, Town Clerk �g•=: 4` -
Town Hall, 53095 Main Road
P. O. Box 1179 lA tn tiRg
Southold, New York 11971 Q `
:.,.„ . :;app-
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Telephone _ol ' t
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT _
SEPTIC TANK or CESSPOOL
• . Operation Permit No. 463 Residential X
Fee $ 10.00 Non-Residential
" Septic Cesspool x
NAME OF OWNER: Caroline Gloeckler
OWNER MAILING ADDRESS: Box 6, Factory Avenue
Mattituck, New York 11952
OWNER PROPERTY ADDRESS: Factory Avenue
Mattituck, New York
OWNER TELEPHONE NUMBER: 516-298-8477 -
TAX MAP NO. : Section 122 Block 2 Lot 19
CROSS STREET: North - Sound Avenue South - Main Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE, OF PREVIOUS PUMP-OUT: Unknown
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Judith T. erry
Southold Town Clerk
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DATE: October 14, 1987 -
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(TOWN SEAL) -
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OFFICE OF THE TOWN CLERKFOCr�Q-
Town of Southold ® Application No. 9 , 3
Judith T. Terry, Town Clerk �� � � '_�+
Town Hall, 53095 Main Road c '° , ''� } Residential
P. O. Box 1179 crs i 'z" i ; Non-Residential _
Southold, New York 11971 0Q VAric/%\"...
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Telephone
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4/60
Fee $/a
DATE .0/ /07
OWNER NAME: CO,e Lj&
OWNER MAILING ADDRESS: rj 6C z' 1/ i 0,
29 . "ve / ,P' //9,5-2-
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OWNER PROPERTY ADDRESS:
c75-/4 'e
OWNER TELEPHONE NUMBER: c29f— ; y77
TAX MAP NO. : Section /2 Z " 2 j f Block 7 ,Vk 9 Lot /
CROSS STREET: "H),) GL:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ' New Existing
Residential / Non-Residential
DATE OF PREVIOUS PUMP-OUT: 5 //f7
LOCATION MAP: Must be attached hereto •efore permit may be issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
AY4-te,
Signature of Applicant
RECEIVED BY: G
Town/Clerk's O fice
RICA"', st
DATE: OCT 14129,T
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Town Clerk Southold
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