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HomeMy WebLinkAboutSchroder 11l` , s ilislet • JUDITH T. TERRY ;A� Town Hall, 53095 Main Road TOWN CLERK P.O. Box 1179 REGISTRAR OF VITAL STATISTICSCOw Southold, New York 11971 MARRIAGE OFFICER N� �r' Fax (516) 765-1823 e,,, �����!` Fax (516) 765-1801 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 1795-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner SCHRODER, RICHARD H. Mailing Address 1 65-37 ADMIRAL AVENUE Mailing Address 2 City St Zip MIDDLE VILLAGE NY 11379-0000 Property Address 1 FLEETWOOD ROAD Property Address 2 City St Zip CUTCHOGUE NY 11935-0000 Owner Telephone No. 718-386-0830 Tax Map No. section 1100 block 4 lot 13.000 Cross Street HAMILTON AVENUE Date Of Last Pump Out 0/00/00 Issue Date: 10/28/91 Judith T. Terry Southold Town Clerk (TOWN SEAL) W t • -OFFICE OF THE TOWN CLERK VFFOU( = f� C� Town of Southold CQ ' Application No. / Judith T. Terry, Town Clerk #.1. : ' Town Hall, 53095 Main Road <r .04 $10.00 - Residential � 7 P. O. Box 1179 cn * �f Vii.. �` $25.00 - Non-Residential Southold, New York 11971 4 ` '' .- � �, Telephone *1 �� `� • (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for - ----- - OPERATION PERMIT - SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ 1- - DATE G� 10 -3 111j OWNER NAME: P /1 ,E2' '// S'C NA C?1� A OWNER MAILING ADDRESS: z- ---137 11i1//teig iffili594e1V144/9 Alf /W, �/,, /11 V _ -- OWNER_PROPERTY AD-DRESS: �-a-trive:3'OP rev. - OWNER TELEPHONE NUMBER: -ice 7/ Yz:, -'0%34:5 TAX MAP NO. : (Section // Block 0444 o Lot: r 0 CROSS STREET: ,/-7//q4iL7 dv yr. TYPE OF SYSTEM: Septic Tank New Existing Cesspool / 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.)_ _ le‘24#Signature of ' pplicant . RECEIVED-'BY BY:at C' TowClerk's Office • DATE: • RECEIVED . • OCT 2 8 1891 town Clerk So l iot4 --�-____-___~--__' � -- - - - U. , ' « ` _ ___ -_ _ ___ ______- - - - -� _____ __ _____ _ __ ___ ________________ _______ ________ __ ___________________________ _,i___ ` ___ ______ - - - - �� ---_---_- --__' -__._ __--� _-__-_-_-_____�_ __ // ��� '��� ����K���*'��/� . ' , - , __-_--__-_----_ --- - --' -- - '-' -'---- - - --' ---'----------'--------- --------------''----------------'-------- ------Q. =�� 6��/Z �� IP ����__.-_----_-_-_--__--___------- -_--_-_-__---_____-_ , `t '- -.- _ -- --' --- ____--_-____�---_'___-__-__-_-_-__.__'_-____--____---___ - _ . �� ______-___'-___ ______ _ _________________ _ _ _-»-' �-' _.-'____-'- --_�__�-__-__-_-__'-__-___ -_'--'_-___-_--_ ______ ---___ -_--_'-- __ _ �^__�______ |_____� ________________.______ __ ' � �� -_� _-�� �� __ y ' - --_-___ - _^__ -_-'__---__-__'_ ___ __-'_- _-'__'_ -__' ______________ -______ ` _-____-______' ---- _ _-'_ _-__--_______.__-__-_-_ ____'------- -- '-_-__ ----_ -___-_---_ - _ __-'--___-- _________________ _-__-- -_ ---� --' _- _ -_-_---___-____-__-___'_---'__-_______ _--. -__--'-' ______ ________ _________________________ . - _- - . _ - -- - _ - -__- --__. --' _-' _- - -'_ __' '-__--' _-' -_-- ___-__________--___-_--_''-___ , _' - - - _- _ _- _ ' __ _ _ ._ _ - -- __ _ __ _____--__ _'___. ___ � IZr= ~- ~ 6 p re�� ~.„* - ' -__-_