HomeMy WebLinkAboutScholl iP
`� Town Hall, 53095 Main Road
P.O. Box 1179
® � Southold, New York 11971
JUDITH T.TERRY
����n„�;r'� FAX(516)765-1823
TOWN CLERK TELEPHONE(516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 974-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner SCHOLL, WILLIAM JR.
Mailing Address 1 1260 BUNGALOW LANE
Mailing Address 2 BOX 72, RFD 1
City St Zip MATTITUCK NY 11952-0000
Property Address 1 1260 BUNGALOW LANE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-8450
Tax Map No. section 123.00 block 2 lot 17.000
Cross Street CENTER STREET
Date Of Last Pump Out 0/00/00
Issue Date: 1/09/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
1 .. /I.
OFFICE OF THE TOWN CLERK 'c51FUL4'
Town of Southold ��� - CQG' Application No.
Judith T. Terry, Town Clerk t, j
Town Hall, 53095 Main Road i'.,,-i- „____-4Residential
P. O.-- Box 1179 a4 Non-Residential
Southold, New York 11971 O`® :0"/
�`�
Telephone =�1 �1% '
. (516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT s
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL `
Operation Permit No. 6/ 71{ -
Fee $ /b. DO
DATE /7,---/V7///,':
OWNER NAME: f!/!1 ti"CHOI-4. Jam.
OWNER MAILING ADDRESS: /24 o &),.C-, L OWJ aA • Vex7)- RFD
/)? 4•7'T/ 7uok: r i'.`:
OWNER PROPERTY ADDRESS: %/2/i.v
OWNER TELEPHONE NUMBER: 21 f- jL/s-c9
TAX MAP NO. : Section /2-3 Block 2 Lot /7
CROSS STREET: CE/V 7 ,€ S7
TYPE OF SYSTEM: Septic Tank _ - New Existing
Cesspool •- 2 New, Existing X
i Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: / 98 g
,LOCATION MAP: Must be attached hereto efore permit may be issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
.
Signature of Applica
RECEIVED; BY: - ' / //r _.-1_ L./„..6
o= n Cle k' • fic-
DATE. - - Is- c2E-,f
•
90
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