HomeMy WebLinkAboutRosenstreich OFFICE OF THE TOWN CLERK • c0f01./(`,"
Town of Southold '. Ol/
Judith T. Terry, Town Clerk C,
Town Hall, 53095 Main Road c u
P. 0. Box 1179 v' `
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Southold, New York 11971 \ O ' - •
Telephone ' O N'
(516) 765- 1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation. Permit No. 604 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool X
NAME OF OWNER: Saul Rosenstreich
OWNER MAILING ADDRESS: 645 Little Peconic Road .
Cutchogue, New York 11935
OWNER PROPERTY ADDRESS: 645 Little Peconic Road
Cutchogue, New York •
OWNER TELEPHONE NUMBER: 516-734-6961
TAX MAP NO. : Section 111 Block 11 Lot 9
CROSS STREET: - Haywaters Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Approx. 1974 -
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Judith T. T ry
Southold Town Clerk
DATE: February 11, 1988 -
(TOWN -SEAL) i
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OFFICE OF TH.r OtIN CLERK c
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Town of Southold ® -._ r& -:" Application No. OY
Judith T. Terry, Town Clerk
�`- � Residential !/
Town Hall, 53095 Main Roadc=3
P. O. Box 1179 u' 3 "k ; ' 14�i ' Non-Residential
Southold, New York 11971 D ®`
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. (4,0
Fee
DATE /Nen
OWNER NAME: Sat./ f Re's ell Si—re-id,
OWNER MAILING ADDRESS: (.,4,45 Lillie Pec."-.4:(..
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: 67lo -- 7 3 '-- 6 {.i
/ -7
TAX MAP NO. : Section ��I Block Lot 7' !°
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: ni / 17v
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 of Applicant
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