HomeMy WebLinkAboutSchreiber 1'® 'G'w4 L ®�
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Town Hall, 53095 Main Road
re.
�� P.O. Box 1179
_0 �s °�r ili Southold, New York 11971
JUDITH T.TERRY � /r���� TELEPHONE
TOWN CLERK (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. 681-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner SCHREIBER, EDITH
Mailing Address 1 840 CLEARVIEW AVENUE
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 840 CLEARVIEW AVENUE
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-2230
Tax Map No. section 70. 00 block 9 lot 60 . 000
Cross Street BENNETT LAND
Date Of Last Pump Out 0/00/00
Issue Date: 4/28/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
''` OF •
OF THE TOWN CLERK •�SFair�'= ,6V
Town of Southold �® ..._ �Q : Application No._6
Judith T. Terry, Town Clerkeft'�
Town Hall, 53095 Main Road -41 Residential
P. O. Box 1179 x *Vat
` Non-Residential
ii
4
Southold, New York 11971
Telephone Ni°i; '�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for"
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
•
DATE (��
OWNER NAME: abl TO CCP, R l alk
OWNER MAILING ADDRESS: 140 C './t irks tee .
, out k.4 s9 t.1 64, y. tq
OWNER PROPERTY ADDRESS: .C4 M t®
OWNER TELEPHONE NUMBER: 7 v rte' Z z
TAX MAP NO. : Section 7O Block Lot id
CROSS STREET: /1t�cG O�ce�/
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool Vs° New Existing %00°'
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.)
(AO' O
fi •
Signature Jaf Applicant
RECEIVED BY: elil:G 7? 1-L
erk's Office
.
RECET. 1
DATE:
APP 2 8-1988
1010 Cler1 Southold
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