Loading...
HomeMy WebLinkAboutSchoch JUDITHOFFRIr T.TERRY ,,I�� =J= '3 i, ._ Town Hall, 53095 Main Road TOWN3:4% TCA) ,t VI P.O. Box 1179 fly Southold New York 11971 REGISTRAR OF VITAL STATISTICS 6 Fax(516) 765-1823 MARRIAGE OFFICER ': �9f� ��®��1 Telephone(516) -1823 765-1800 RECORDS MANAGEMENT OFFICER - 3 ,� FREEDOM OF INFORMATION OFFICER s' OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 3703-R Residential X Non-Residential Fee $ 10.00 New Existing X Name Of Owner SCHOCH, MILDRED R. Mailing Address 1 247-55 90TH AVENUE Mailing Address 2 City St Zip BELLEROSE NY 11426-0000 Property Address 1 750 SMITH LANE Property Address 2 City St Zip PECONIC NY 11958-0000 Owner Telephone No. 718-343-4532 Tax Map No. section 98.00 block 3 lot 31 .000 Cross Street SMITH ROAD Issue Date: 10/21/97 Judith T. Terry Southold Town Clerk (TOWN SEAL) I• •. .... OFFICE OF THE TOWN CLERKS��FQC� � a //w�� Town of Southold % CQG_� Application_ NoS-� 0 Judith T. Terry, Town Clerk r�; ` $10.00 - Residential`/ /O d 0 Town Hall, 53095 Main Road P. 0. Box 1179 $25.00 - Non-Residential Southold, New York 11971 0V•,••�` Telephone v.( Nit , • (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit Nb. Fee $ 0 0 • DATE / 0 / i / 7 OWNER NAME': F OWNER MAILING ADDRESS: -+7-5S- 7 0 T/f /+-fe ✓3 51"4-'17-7 ��� I= KI `f ( // L > c / OWNER PROPERTY ADDRESS :_____S'0 $/y ( 7-/-1 G ice( N c_ L ' ' 4 OWNER TELEPHONE NUMBER: r7 l $ - 3 Li-. 3 - 5- 3 3--- , TAX MAP NO. : Section 09 ff 60 Block 0_3 ©`a Lot 03 / 000 CROSS STREET: .$ /-I 11- H o A 10 TYPE OF SYSTEM: Septic Tank New Existing Cesspool � New Existing Residential Non-Residential • 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.) Signature of Applicant RECEIVED BY: Town C erk's Office DATE: T (...2 4 i 5 ili tr frf. K. 0Aio , ZII ig ; lkiii '"( ++ 0 Q, 7 . -e• ' %<---------) F I P- 5e o s