HomeMy WebLinkAboutRosenberg OFFICE OF THE TOWN CLERKU
Town of Southold �(%�
Judith T. Terry, Town Clerk •
h. P.,;\ '�
Town Hall 53095 Main Road = '
P. O. Box 1179 cn ' V "
Southold, New York 11971 p
Telephone4111�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation. Permit No. 525 Residential x
Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: Gertrude Rosenberg
OWNER MAILING ADDRESS: Box 134
Peconic, New York 11958
OWNER PROPERTY ADDRESS: Indian Neck Lane
Peconic, New York 11958
OWNER TELEPHONE NUMBER: 516-734-6238
TAX MAP NO. : Section 98 Block 5 Lot 17.5
CROSS STREET: Robinson Lane
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: June 1985 _
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Judith T. T�
Southold Town Clerk
DATE: December 8, 1987
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(TOWN SEAL)
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OFFICE OF THE TOWN CLERK COMA' r
Town of Southold \ * CQG Application No. _
Judith T. Terry, Town Clerk ' �;,-, `
_ ;: 4 I Residential
Town Hall, 53095 Main Road
P. O. Box 1179 � � yi��` Non-Residential
Southold, New York 11971 O
Telephone .( 444 �►
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for -
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. ` 1j
Fee $ l d
DATE /WO-7
OWNER NAME:
€12-( y` U �� � S6.)\1-5 L
OWNER MAILING ADDRESS: D l 3a
CO( tt f( 9 ( d
OWNER PROPERTY ADDRESS: SA E
OWNER TELEPHONE NUMBER: ((t? 3 Y 6p3
TAX MAP NO. : Section Block Lot
CROSS STREET: IVO (!C
TYPE OF SYSTEM: Septic Tank ,New Existing
Cesspool New Existing
Residential I/ Non-Residential
DATE OF PREVIOUS PUMP-OUT: " U N (= kf
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 o Applicant
RECEIVED BY: 4/ ,0/
To erk's Office
DATE: h/g/
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