HomeMy WebLinkAboutSchmidt OFFICE OF THE TOWN CLERK ' c,VFFU(k
Town of Southold 0�� BOG
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road a i .. rr
P. O. Box 1179 ;("3
Southold, New York 11971 4 -,&‘c-•••�
Telephone : l t N
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 77 Residential xx
Non-Residential
Fee $ 10.00
Septic Cesspool xx
NAME OF OWNER: Helene J. Schmidt
OWNER MAILING ADDRESS: North Road, P.O. Drawer K
Greenport, New York 11944
OWNER PROPERTY ADDRESS: Main Road
Orient, New York 11957
OWNER TELEPHONE NUMBER: 516-477-1832
TAX MAP NO. : Section 18 Block 2 Lot q4
CROSS STREET: Platt Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool xx New Existing xx
Residential xx Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
Judith T. Terry
Southold Town Clerk
DATE: October 2, 1986
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(TOWN SEAL)
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OFFICE OF THE TOWN CLERK
Town of Southold �� � �� Application No.
Judith T. Terry, Town Clerk 44
Residential c//
Town Hall, 53095 Main Road c �^�• 'N,P.
P. O. Box 1179 c!-3 Non-Residential
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Southold, New York 11971 O 0� .•
Telephone *0 � -,
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 7?
Fee $ /U
DATE &thia /j/771
OWNER NAME: Neh?ze• . Sc4 / d 1
OWNER MAILING ADDRESS: �1.-14 kb. ' (P 0• . 44Jye L )
Rrz=a P T, ti .k, 49SAY
OWNER PROPERTY ADDRESS: aii,'GfiMr, �Y- le,t;fN42470/
OWNER TELEPHONE NUMBER: 637 4 ) tipp -T
TAX MAP NO. : Section /8 • — Block o. Lot 3
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing 1/".
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.)
ht-elteez
Signature of Applicant
RECEIVED BY:aiw
TowriClerk' Office
DATE: 02-
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