HomeMy WebLinkAboutSchott JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK ® t P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
�i�� Fax (516) 765-1823
MARRIAGE OFFICER ��•!' Fax
(516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1892-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing' X
Name Of Owner SCHOTT, STEPHEN J.
Mailing Address 1 RR 01 1235 CEDAR DRIVE
Mailing Address 2
City St Zip EAST MARION NY 11939-0000
Property Address 1 1235 CEDAR DRIVE
Property Address 2
City St Zip EAST MARION NY 11939-0000
Owner Telephone No. 516-477-2279
Tax Map No. section 22.00 block 2 lot 44.000
Cross Street SOUTHERN BOULEVARD
Date Of Last Pump Out 0/00/00
Issue Date: 4/28/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
ir
OFFICE OF THE TOWN CLERK C��FiFULea
Town of Southold �� CQ Application No. /IPS
Judith T. Terry, Town Clerk h i9 T
Town Hall, 53095 Main Road
$10.00 - Residential
p. O. Box 1179 523 ft PeAl $25.00 - Non-Residential
Southold, New York 11971 ®, ,
Telephone (
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for—
OPERATION
or `OPERATION PERMIT .
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /e),
DATE , /74='1=-
OWNER NAME: 57 W
OWNER MAILING ADDRESS: NO/o/ , 3S C A..
a-S Mood NY //9?9
OWNER PROPERTY ADDRESS: „57, 6: •
-
OWNER TELEPHONE NUMBER: ,/77-0?0?79
TAX MAP NO. : Section ,201_ Block ,.2 Lot °9:Y.
CROSS STREET: Svc.) 6deiti ,Q,zV0
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool v 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.)
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Sign u ve of Applicant
RECEIVED`BY: REccig ,. •. -_ _ _
Town Clerks + ' e
DATE: APR 2799?
Town Clerk Souti old
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NOTIFY BUILDING DEPARTM NT AT m f
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765-1802 9 AM TO 4 PM Ft R THE I o
' FOLLOWING INSPECTIONS: I in
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FOR POURED CONCRETE D.'.1NG01 ih
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3. INSULATION 0
4. FINAL - CONSTRUCTION UST •
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ALL CONSTRUCTION •SHALL EET
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THE REQUIREMENTS OF THE J. Y. i ,
CONSTRUCTION & EN RGY ;yG
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