HomeMy WebLinkAboutSailer •
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JUDITH T.TERRY Town Hall, 53095 Main Road
TOWN CLERK = t'y z P.O.Box 1179 _
^? �� Southold,New York 11971-
REGISTRAR OF VITAL;STATISTICS ✓ . - O p��� Fax(516) 765=1823
MARRIAGE OFFICER ` .
RECORDS MANAGEMENT OFFICER - y_�0.1 ' 'j,d� Telephone(516) 765-1800 ,
FREEDOM OF INFORMATION OFFICER �- , , ••0.
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD ,WASTEWATER DISPOSAL PERMIT
• 'OPERATION PERMIT
` SEPTIC TANK or CESSPOOL
Operation Permit No. 3448-R ,, Residential ,X Non-Residential_ ,
Fee $ 10.00 -. , New Existing X
Name Of Owner SAILER, GEORGE JR.
Mailing Address 1 40' 5 STILLWATER AVENUE
Mailing Address 2
' City St Zip ' , '- CUTCHOGUE NY 11935-0000
Property Address 1 : -4075 'STILLWATER AVENUE
Property Address 2 - • - '
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-7659
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Tax Map No. section, 137:00 block 1 lot 8.001
Cross Street - TRACK AVENUE '
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Issue Date: 3/15/96 - Judith T. Terry
Southold Town Clerk -
(TOWN SEAL) '
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6FFICE OF THE TOWN CLERK c�VFF0/1(p"
Town of Southold ��� CQG Application No. u ��"
, �'.
Judith T. Terry, Town Clerk V - y •
Town Hall, 53095 Main Road a -< 1 $10.00 - Residential ---'
P. O. Box 1179
Southold, New York 11971 O ���� $25.00 - Non-Residential
Telephone *e.( * Or.
(516) 765-1801
TOWN OF SOUTHOLD
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SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE _g/>. /;;4
OWNER NAME: George Jf.
4075 Stillwater Ave,
OWNER MAILING ADDRESS: Cutchogue, NY 11935
OWNER PROPERTY ADDRESS: George Sailer
4075 Stil!watcr•c.
Cutchogue, NY 11935
OWNER TELEPHONE NUMBER: ,7�/
TAX MAP NO. : Section Block /J Z /Lot
CROSS STREET: ��gce
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool // New Existing
Residential Non-Residential
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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igna ure oAppli nt
RECEIVED BY:
Town Clerk's Office • -
DATE:
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- 'MAP OF LAND Lot No. 14 guaranteed to The
swzveYev FOR Title Guarantee Company
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