HomeMy WebLinkAboutSchiller Town Hall, 53095 Main Road
1P.O. Box 1179
�®i�� Southold, New York 11971 22 it 1
JUDITH T.TERRY =_ i�� TELEPHONE
['OWN CLERK
// (516) 765-1801
REGISTRAR 01VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 634-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner SCHILLER, EDWARD F.
Mailing Address 1 BOX 471
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 540 CEDARS ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-5686
Tax Map No. section 109. 00 block 5 lot 17.000
Cross Street NEW SUFFOLK ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 3/03/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
.. .i
OFFICE OF THE TOWN CLERK 0,VYFU c1
Town of Southold � Application No. 3/
Judith T. Terry, Town Clerk 3 k�
Town Hall, 53095 Main Road Residential
P. O. Box 1179 4 � .' Non-Residential
Southold, New York 11971 O ®
Telephone "fet
'� et
,
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
For
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ " 00
DATE 2//.of
OWNER NAME: /4-7,
f
OWNER MAILING ADDRESS: �y, 9(7
C607-- t-i-013.--- /Vv 1193
OWNER PROPERTY ADDRESS: Cr.�.9r�S
Cv'7-c c(0 TUB / 193-s
OWNER TELEPHONE NUMBER: -2 4 Li—
TAX MAP NO. : Section /pc7,. 00 Block ('�, 00 Lot ®I'7 . OO
CROSS STREET: /recm &J J j(L- 4c
TYPE OF SYSTEM: Septic Tank New Existing x
Cesspool v - New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: 5'j 2
LOCATION MAP: Must be attached hereto befor- perms may be issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
/1.4
Signature of A plj,e'ant
RECEIVED BY: eziLdu
Town Jerk's ffice
DATE: `gig/tr"
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