HomeMy WebLinkAboutSchriefer OFFICE OF THE TOWN CLERK F�
Town of Southold
Judith T. Terry, Town Clerk 00
Town Hall, 53095 Main Road
.0141 tri
P. 0. Box 1179 1 01 tiA
Southold, New York 11971p '®
Telephone : 1
(516) 765-1801 •`"
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 464 Residential X
Non-Residential
- Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: Clifford K. and Jeannette Schriefer
OWNER MAILING ADDRESS: Box 223
Cutchogue. New York 11935
• OWNER PROPERTY ADDRESS: Fawn Lane
Cutchogue. New York
OWNER TELEPHONE NUMBER: 516-734-5307
TAX MAP NO. : Section 103 Block 4 Lot 71
CROSS STREET: Beebe Drive
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential x Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
Southold To Clerk
DATE: October 14, 1987
7 (TOWN SEAL)
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OFFICE OF 1-HE TOWN CLERK c0FUL -C.G
Town of Southold Application No. L.6.
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road c � r Residential
1411 P. 0. Box 1179 v' ` Non-Residential
Southold, New York 11971 O
Telephone *6,
(516) . 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 444
Fee $ /Q, 00
DATE /p/6/ '`,
OWNER NAME: (/i 144 l � ��7/�/e
OWNER MAILING ADDRESS: i3 plc as 3
�i -74'_AUe . /1� / //
v
OWNER PROPERTY ADDRESS: �22�,.2._
6 ( rle' ! /1.2
OWNER TELEPHONE NUMBER: 73 — �G
TAX MAP NO. : Section /p 3 Block 7 Lot o2 3
CROSS STREET: Qrtu
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing v
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: 2'o/ c597
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.)
Signature of Applica
RECEIVED BY: `-'&/1,
RECEVIEJ own Cler Offi ye
DATE: OCT/41C 7
Town Cl rh So, hood
i1/4/04 7D
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