HomeMy WebLinkAboutGluckman OFFICE OF THE TOWN CLERK ' COFO(,r
Town of Southold ‘t.0- CD
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road ; •
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P. O. Box 1179
Southold, New York 11971 ;ol.o 0�,,�� - -
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 29 Residential xx
Fee $ 10.00 Non-Residential
Septic Cesspool-' ~
NAME OF OWNER: Richard Gluckman
OWNER MAILING ADDRESS: 463 Greenwich Street
New York, New York 10013
OWNER PROPERTY ADDRESS: Main Road
Orient, New York
OWNER TELEPHONE NUMBER: 212-925-3967 (Office)
TAX MAP NO. : Section 18 Block 6 Lot 7
CROSS STREET: mile east of Platt 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. Terry
Southold Town Clerk
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DATE: August 26, 1986
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK �S���FO(,ie:.
Town of Southold &,%-_ -- CV: Application No. of
Judith T. Terry, Town Clerk k ' . '. . j'`7 Residential
Town Hall, 53095 Main Road *A.`._ . : -
P. O. Box 1179 cn ' .`' Non-Residential
Southold, New York 11971 O ® ' 1�'
Telephone _e.( %�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. c:,?,
Fee $ /00
DATE 24 /'Vrio
OWNER NAME: 15/ ,H4)2 6Z LieZm4x)
OWNER MAILING ADDRESS: '/f3 67,/c3 -71,71,14 Jg 9 7
,l Ail i obi 3
OWNER PROPERTY ADDRESS: rr4//u , j�,0
C3 / , /V
OWNER TELEPHONE NUMBER: 212/ 672,5 5eW.- .DFPk6
TAX MAP NO. : Section c7/ g Block ' Lot 7
CROSS STREET: it 1 f'YIjLJ 6--,67 ( f1.7f ID
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool DL New Existing
Residential SI---- Non-Residential
DATE OF PREVIOUS PUMP-OUT: '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.)
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_ .�41.144( 1 Ai
llSig 're of Applicant
RECEIVED BY: ,
Town Ierk's ffice
DATE: . ,c,?�, /Ff
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