HomeMy WebLinkAboutSchlachter itto time sir
JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK ® , P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
c� Fax (516) 765-1823
MARRIAGE OFFICER ®�� ®'6' Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1864-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner SCHLACHTER, CHERYLE LEE
Mailing Address 1 BOX 145
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 3225 YOUNGS AVENUE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-1972
Tax Map No. section 55.00 block 5 lot 3.000
Cross Street NORTH ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 3/31/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OF'FICE OF THE TOWN CLERK cvFFUL'
Town of Southold CQ Application No. /g _
Judith T. Terry, Town Clerk �
Town Hall, 53095 Main Road U �, $10.00 - Residential
p. O. Box 1179 $25.00 - Non-Residential
Southold, New York 11971 O 'cab
Telephone.( ‘N‘60 '�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
(Y� C °��" DATE_J 2,0 I q1 ql I
Affij
OWNER NAME: heV (/( Lee_ 3cik��ck1
OWNER MAILING ADDRESS: Pei &'>( eft- 1?
61,/ 1d, N.c . (1_q-p
OWNER PROPERTY ADDRESS: yAVLW Q 32.25
• V5651&4,6161 /0 .y . /I /1/
OWNER TELEPHONE NUMBER: /65 /C7Z
TAX MAP NO. : ' Section 5-6—
Block 055 Lot _ C�
CROSS STREET: 1W6La� SSPI2M( P0/41)
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
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.)
I / /
ignature of Applicant
RECEIVED BY:
leve+;• rk's Office
DATE: MAR 3? 1
Tim Clerk Southold
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