HomeMy WebLinkAboutScholtz Zd�I�`� I ' ..�.
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• Town Hall, 53095 Main Road
. ��`' P.O. Box 1179
���' Southold, New York 11971
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® �,.t' TELEPHONE
JUDITH T.TERRY (516) 765-1801
TOWN CLERK
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. 895-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner SCHOLTZ, EDWARD J.
Mailing Address 1 BOX 84
Mailing Address 2
City St Zip LAUREL NY 11948-0000
Property Address 1 MAIN ROAD
Property Address 2
City St Zip LAUREL NY 11948-0000
Owner Telephone No. 516-298-8803
Tax Map No. section 127.00 block 1 lot 3.001
Cross Street ALDRICH LANE
Date Of Last Pump Out 0/00/00
Issue Date: 11/01/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
` '� -• III II
OFFICE OF THE TOWN CLERK SVF
Town of Southold A4. CQ"%`', Appli-cation
Judith
Judith T. Terry, Town Clerk �` A
1 Residential
Town Hall, 53095 Main Road 8 Fgrr •-
P. O. Box 1179x� � Non-Residential
Southold, New York 11971 O�O�A • ��0� ���`
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for -
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. Fq_5
Fee $ JO ioo
DATE 10 /9 -- tfC�
OWNER NAME: ,1 . i / �i
OWNER MAILING ADDRESS: C' 3 -.1Kj
g7�Gia'J. Y,��T r t ✓9��
OWNER PROPERTY ADDRESS: 2242..4.0.52_, Q4-' a v`e-
OWNER TELEPHONE :NUMBER: G o7 ?g•- Ego 3
TAX MAP�N�O. : Section / 7 Block . f Lot l
CROSS STREETu
S-on Tlgde 671e4 4/ riJ) / A/
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ,X New Existing ' \
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.)
Signati e of Applic.(
•
RECEIVED BY: %�-' _ . . //
To n C -rk s •ffice DATE: - / 0/,z5/ed-
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