HomeMy WebLinkAboutSchineller OFFICE OF THE TOWN CLERK • c FO1X
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Town of Southold
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Judith T. Terry, Town Clerk Z „. x
Town Hall, 53095 Main Road
P. O. Box 1179 cnk g
Southold, New York 11971 p Y®. \•�-�•�
Telephone �j
(516) 765-1801 •-
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 383 Residential x
Fee $ 10.00 Non-Residential
Septic Cesspool •X
NAME OF OWNER: William J. and Ruth M. Schineller
OWNER MAILING ADDRESS: P.O. Box 146
East Marion, New York 11939
OWNER PROPERTY ADDRESS: 285 East Gillette Drive
East Marion, New York •
OWNER TELEPHONE NUMBER: 516-477-1685
TAX MAP NO. : Section 38 Block 4 Lot 10
CROSS STREET: Manor
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
Judith T. Terr
Southold Town Clerk
DATE: August 3, 1987
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK �FFD
Town of Southold �o�J 4 Application No.
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road " I Residential
P. O. Box 1179 U' Y'' T°, hi ,' Non-Residential
Southold, New York 119714,2; .
Telephone mt [ �� to
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. c5,..3
Fee $ lb
DATE
OWNER NAME: Q 6,077( )2k/9.
,,- /. , jA/ / £,e
OWNER MAILING ADDRESS: .R. 0, /f
OWNER PROPERTY ADDRESS: �, �� �¢,
/7 /,/9--49
OWNER TELEPHONE NUMBER:
TAX MAP NO. : Section 3g- Block 2/ Lot /®
CROSS STREET: A.*,9-10®o�
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool g/ New Existing 17-
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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.)
td,, '
ignature of Applicant
RECEIVED BY:
RE` Tow CJ rk's Off ce
DATE: A(ic Q3 i9c
Town Clerk Southold
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