HomeMy WebLinkAboutSchaefer OFFICE OF THE TOWN CLERK • •c.31FULkr-
Town of Southold (b., �l/y
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road e.
P. O. Box 1179 v' � w +' g •
Southold, New York 11971 Q ` _ •�
Telephone = ®1
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 248 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool x
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NAME OF OWNER: John R. Schaefer
OWNER MAILING ADDRESS: 3950 Old North Road
Southold,' New York 11971 •
OWNER PROPERTY ADDRESS: 3950 Old North Road
Southold, New York
OWNER TELEPHONE NUMBER: 516-765-3784
TAX MAP NO. : Section 55 Block 2 Lot 3
CROSS STREET: Youngs Avenue
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: December 4, 1986
Judit
Southold Town Cle
DATE: March 31 , 1987
(TOWN SEAL)
OFFICE OF THE TOWN CLERK ��FF�(��'-
Town of Southold , � 4 - YCO�� Application No. ace
Judith T. Terry, Town Clerk ; y
Town Hall 53095 Main Road r<' 1 Residential X
P. O. Box 1179 y' 4)1 Non-Residential
Southold, New York 11971 ® rjO ��`
Telephone
(516) 765-1801 1
TOWN OF SOUTHOLD
•
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
far -
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. (7,?V/
Fee $ 10.00
DATE March 30, 1987
OWNER NAME: John R. Schaefer
OWNER MAILING ADDRESS: 3850 Old North Road,
Southold9 N.Y. 11971
OWNER PROPERTY ADDRESS: same
OWNER TELEPHONE NUMBER: 765 3784
tl
TAX MAP NO. : Section 55 Block 2 Lot 3
CROSS STREET: Youngs Ave.
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: December 4, 1986
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 Applican
RECEIVED BY: ( )
Tow Clerk's Office
RECEIVED
DATE:
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Y 50198/
Town Clark Southold
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John R. Schaefer
ZLL 3950 Old North Road
Southold, N.Y. 11971