HomeMy WebLinkAboutSchlecht V4 '
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M r Town Hall, 53095 Main Road
izarz
t r• P.O. Box 1179
_� ® sem, !�`v i��iP' Southold, New York 11971
JUDITH T.TERRY `� /IFAX(516)765-1823
TELEPHONE(516)765-1801
TOWN CLERK
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 963-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner SCHLECHT, JOHN A.
Mailing Address 1 56425 NORTH ROAD
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 56425 NORTH ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-2096
Tax Map No. section 44.00 block 1 lot 24.000
Cross Street ALBERTSON LANE
Date Of Last Pump Out 0/00/00
Issue Date: 12/19/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK 'A `'
Town of Southold = ', Oc��FFO(�'`,
ff Q ' Application No. 963
Judith T. Terry, Town Clerk € . ii 4A
Town Hall, 53095 Main Road 8 ,, Residential
P. O. Box 1179 to '` ��' Non-Residential
Southold, New York 11971 O
Telephone :_ ( •
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT -
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ • ,
DATE ‘ti .. .0 —LckCirl
OWNER NAME: \J 4\ • S c
OWNER MAILING ADDRESS: S11:41--S.'
1:42-- \J-04
"c.5\lew \J • 1 tick?V
OWNER PROPERTY ADDRESS: 6 2 \c,
pO i0L0 \J ,f, ktq
OWNER TELEPHONE NUMBER: 77,( % —2-nC,r
TAX MAP NO. : Section �- -� Block I Lot �,""t
CROSS STREET: V 'o 9--t14%--9
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.)
• SC-cige-f-S .
'gnature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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