HomeMy WebLinkAboutScholl •,11 safFatir
am® _.4
JUDITH T.TERRY .'• . �� Town Hall, 53095 Main Road
TOWN CLERK .fx ; P.O. Box 1179
,, s ,i Southold,New York 11971
REGISTRAR OF VITAL STATISTICS ‘'°'o ' i� >'� ,�1 Fax(516) 765-1823
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER :���� ��®i.� Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER ��'
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3559-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner SCHOLL, DONALD P. AND THOMAS M
Mailing Address 1 350 ROBINSON LANE
Mailing Address 2
City St Zip PECONIC NY 11958-0000
Property Address 1 1535 PARK AVENUE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-496-4288
Tax Map No. section 123.00 block 2 lot 31 .000
Cross Street MARRATOOKA ROAD
Issue Date: 12/05/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
II Iii
OFFICE OF THE TOWN CLERK SIFIU
Town of Southold �� ., ,TM CQ Application No,3 S-5 /
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road f: t4 $10.00 - Residential_
P. O. Box 1179 w;' 1,. t $25.00 - Non-Residential
Southold, New York 11971 O`� R`*Vcr�®�,���`
Telephone , 1 •
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE 1.).--'-5 t.
OWNER NAME: 04ALs) •\Qmhs M . . C.1-.1o `"-
OWNER MAILING ADDRESS: 3bo rlo 6.; as0ra LAS
c- Ny . htirg-
OWNER PROPERTY ADDRESS: 1 ,I-3( PACK ►WJE.
ma . / A 1
OWNER TELEPHONE NUMBER : ccut-0 14,(i -'\ 2,%% _
TAX MAP NO. : Section j 2 � Block Lot 3
CROSS STREET: I)A}MA 5 0 o t o ickb
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing p(
Residential 0< 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.)
41111
").Sik
Si. - .cir •f Applicant
RECEIVED BY:
Town Clerk's Office -
DATE:
IV
1 \-\
•
\ ',;?51'-o"i'i ,
. \
1
I
/ ,1":
1
l
ROUSE `?r.°s—
2
Z I, 8 �a II l
/171- 'iV/--- l'
et
I i 11.1
o
I
A \� ___
L.1 S F \-oWS fCZ
3
�RrM
i ►J1T 0 i3 ,
1
60 T\A c ESS v cc LS A i2 f
CoN ST (ZvcTn oF. 1-1'A1.1 .
ZY------ -
- �We \� GONCZ .l� �1, o C� . _�_____i _-
i
t
1
J+II
l
- - - 0 --