HomeMy WebLinkAboutSchoetzau 61."CO F gljtA
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1c %, Town Hall, 53095 Main Road
;0� -O�`�' P.O. Box 1179
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•0$ Southold, New York 11971
JUDITH T. TERRY ''��m# .40" TELEPHONE
TOWN CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
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SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1101-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner SCHOETZAU, ELIZABETH
Mailing Address 1 BOX 412
Mailing Address 2
City St Zip GREENPORT NY 11944-0000
Property Address 1 190 GULL POND LANE
Property Address 2
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City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 516-477-0533
Tax Map No. section 35.00 block 3 lot 5.000
Cross Street ROUTE 25
Date Of Last Pump Out 0/00/00
Issue Date: 5/09/89 Judith T. Terry `
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK cl\TFO(,r
Town of Southold e&---• Application No. //Q/
Judith T. Terry, Town Clerk ' '. .� ,,,--,z,-7--,,„
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Town Hall, 53095 Main Road 8 IA' i Residential
P. O. Box 1179 to =x L; y.'• i ;' Non-Residential
Southold, New York 11971 O _ , _O�'�
Telephone ,( '
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ c,
DATE .f` 9 — f
OWNER NAME: ��6t 4-,63 e-7-74 .96I ETZ/fjG
OWNER MAILING ADDRESS: /9D Ga// "pi,j 4-4 , balk `! i-
OWNER PROPERTY ADDRESS: / 90 6v /1 Ao 44' '
0 i,,•,-10 �-- b y /iq y y
OWNER TELEPHONE NUMBER: V7-7-05-33
y TAX MAP NO. : Section 3----- Block 3 Lot 3----
CROSS STREET: e-/b-- (9._. —
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TYPE OF SYSTEM: Septic Tank New Existing
Cesspool r/ New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: atAAL
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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.)
Sit re of Ap cant
RECEIVED BY: ,CX_P-j-il(--,----"
Town Clerk's Office
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DATE: � C/ q �
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