Loading...
HomeMy WebLinkAboutSchaaf "l'L,/�vo/%1y1�/III//II/,Ip%pI�I%�/f,(p /'111. �l,q�11 lW�'U ... - iY t9 iP ' a M Town Hall, 53095 Main Road `' P.O. Box 1179 ®�;!' Southold, New York 11971 —�® si TELEPHONE JUDITH T.TERRY TOWN CLERK (516) 765-1801 REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 880-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner SCHAAFF, GERALDINE COLLEN Mailing Address 1 P. O. BOX 1142 Mailing Address 2 City St Zip MATTITUCK NY 11952-0000 Property Address 1 770 PIKE STREET Property Address 2 City St Zip MATTITUCK 11952-0000 Owner Telephone No. 516-298-8287 Tax Map No. section 140.00 block 3 lot 6.000 Cross Street LOVE LANE Date Of Last Pump Out 0/00/00 Issue Date: 10/12/88 Judith T. Terry Southold Town Clerk (TOWN SEAL) J dis III OFFICE OF THE TOWN CLERK IfMIAL' Fro Town of Southold ��� . . CQ Application No. Judith T. Terry, Town Clerk .� `` �► Town Hall, 53095 Main Road Residential t!7 = P. O. Box 1179 t. ��, , ZNon-Residential Southold, New York 11971 O ts_ "qt.��` Telephone 701 AKA (516) 765-1801 V TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT V SEPTIC TANK or CESSPOOL Operation Permit No. , Fee $ /G:O0 V DATE /' -6 - OWNER NAME: /`7/eS C70C Z 6'41 5c/51 ,4F1 OWNER MAILING ADDRESS: /3"p,X //.2 M,11—T.Tv G g / NY V //9.C--Z OWNER PROPERTY ADpRESS: 77© /�i/<".e' S'T /Y/ 77 7/G<- OWNER TELEPHONE NUMBER: 6'/1 a-9cf. ,a 7 TAX MAP NO. : Section /e6) Block 3 Lot 46 CROSS STREET: /64,4.r. TYPE OF SYSTEM: Septic Tank New Existing Cesspool � New Existing f Residential Non-Residential DATE OF PREVIOUS PUMP-OUT: .2 - .2-.1"49--- LOCATION .-J'JLOCATION 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.) • /"Oir-;/ Sig ure of A ' ant • RECEIVED BY: 0&-.7cc£...-Q Tom/6 Cler 's Office , REIN£°y°` :� DATE: 6611 k,88 Town Clerk Southold • \ 9 0 N k N / (14 1IQ fl \_. h Ft4 , 0 0 itt /t % L E