HomeMy WebLinkAboutSchmitt OFFICE OF THE TOWN CLERK cOf
Town of Southold � a` ® �
Judith T. Terry, Town Clerk -
Town Hall, 53095 Main Road 94i %Wit
P. 0. Box 1179
Southold, New York 11971 F � ��•
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 373 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool_ X
NAME OF OWNER: Edward I. Schmitt _
OWNER MAILING ADDRESS: 9180 Sound Avenue
Mattituck, New York 11952
OWNER PROPERTY ADDRESS: 9180 Sound Avenue
Mattituck, New York
OWNER TELEPHONE NUMBER: 516-298-4012
TAX MAP NO. : Section 122 Block 2 Lot 2
CROSS STREET: Factory Avenue
TYPE OF SYSTEM: Septic Tank New Existing .
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: August 27, 1985
Judith T. Terry
Southold Town Clerk
DATE: July 29, 1987
(TOWN SEAL) -
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OFFICE OF THE TOWN CLERK CO F, ►
Town of Southold
,..s .-Ar, CSG'` Application No. 37`3
Judith T. Terry, Town Clerk - I Residential
Town Hall, 53095 Main Road 1'__
P. O. Box 1179 cni ; Non-Residential
Southold, New York 11971 i ? S
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Telephone 101 0 `1\ .”
•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /0
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OWNER NAME: ii, w D
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OWNER MAILING ADDRESS: ell <o S D 0 et o _
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OWNER PROPERTY ADDRESS: CO------vv g --
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OWNER TELEPHONE NUMBER: �1 75 ''/ a I `-a.
TAX MAP NO. : Section l a A Block a, Lot a
CROSS STREET: je, at
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing L...-----
Residential
./Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: 1l--A7-g's® lip ser pee.emi- - 5 -f 9
LOCATION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow and feet
of distance, approximately, tobuilding a' d cle.. st oad.)
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RECEIVED BY:
Town Clerk's Office
DATE:
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