HomeMy WebLinkAboutSchold � .z
,� -. ' ' $ Town Hall, 53095 Main Road
� ��`� P.O. Box 1179
-_ ® , �b .i' Southold, New York 11971
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JUDITH T.TERRY :- ��� �i�� ���� TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERIC
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 672-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner SCHOLD, KENNETH N. & IRENE
Mailing Address 1 P.O. BOX 24
City St Zip PECONIC NY 11958-0000
Property Address 1 SOUNDVIEW AVENUE
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-2821
Tax Map No. section 59. 00 block 6 lot 1. 000
Cross Street KENNEYS ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 4/25/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFfi•ICE' OF THE TOWN CLERK '' qFD
Town of Southold 'c „07,-.7,:%,:-‘,6_, Application No. 7°2--
Judith
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Judith T. Terry, Town Clerk v `'z �'
Town Hall, 53095 Main Road ® . ' {{l� -a4w..- 1 Residential
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P. O. Box 1179 cry Non-Residential
Southold, New York 11971 f ` ' 'S
Telephone ®.l , ��
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
- for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /d • r
DATE A) / 2--C-791
OWNER NAME: e `Lei ' Sc e iip/
OWNER MAILING ADDRESS: ft' ..597c ter" 1.1•, ►r ,
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OWNER PROPERTY ADDRESS: �j.;/i T cr ,.c r.) -
OWNER TELEPHONE NUMBER: _5/6 " �5 g�/
TAX MAP NO. : Section CT 5' Block & Lot /
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CROSS STREET: its---i Ai S ed ,
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
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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.)
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Signature of Applicant /
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RECEIVED BY: w4.,,L „ c____% td „',,
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Town Cle is Offcc:
DATE: Cit c . - - ( - V
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