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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 r 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: "j ► 3 Y 50198/ Town Clark Southold . .k,// 7 aed)zeite,L e/( . John R. Schaefer ZLL 3950 Old North Road Southold, N.Y. 11971