HomeMy WebLinkAboutSchroeder ''e gf�L�
Co
Town Hall, 53095 Main Road
c.RP.O. Box 1179
�N9® 0 ''��!I. Southold, New York 11971
H
JUDITT.TERRY Y'' - 00,-1 FAX(516)765-1823
TOWN
CLERK TELEPHONE(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. 1349-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner SCHROEDER, MARILYN E.
Mailing Address 1 7705 NORTH BAYVIEW ROAD
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 7705 NORTH BAYVIEW ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-2041
Tax Map No. section 79.00 block 4 lot 18.000
Cross Street BRIGANTINE DR. 8 TOP SAIL DR.
Date Of Last Pump Out 0/00/00
Issue Date: 12/19/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK �I1WPO
Town of Southold ��� ,�_� CQG'; Application No./34?
Judith T. Terry, Town Clerk �u.K:fs fi,`` ;.
x •. `y $10.00 - Residential •
Town Hall, 53095 Main Road
p. O. Box 1179 to :rt :�. �,'. '
� ;� � �_,�f� $25.00 - Non-Residential
Southold, New York 11971 4 ® .-.V .
Telephone %-‘41('-
(516)
Q( `�►�
(516) 76571801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL'./DISTRICT
APPLICATION
for - -
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ / ób
DATE /a2 " /5- SCJ
'OWNER NAME: 4/4/ 2..)//v .SC /"f R0 E D E R
OWNER MAILING ADDRESS: 77-0.57:- d Bay Vic tit/ v.d .
$ou7 Lc - N y1 - // 97
N.w.
OWNER PROPERTY ADDRESS: iV I3A�' Vc W �d "Caa^.o B1634, t;eVe Dr,v� -
SA jrire,
:, .OWNER TELEPHONE NUMBER:
76.45-- Z041
TAX MAP NO. : Section 7 9 Block 4 Lot / e
CROSS STREET: 13'0;i3Wl7Ne IriVe FIN'carseclienfelka11/Fl wra•*1arSAilirrit/�
TYPE OF SYSTEM: Septic Tank yEs' NewayxaRS Existing
Cesspool yes New Existing y $ r-s ,
Residential yES Non-Residential
DATE OF PREVIOUS PUMP-OUT: /I/oV,".3 - eecer.it 'ess ao`L Secv�aa
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-.)._ -
tel.
/gnat - of Applicant
RECEIVED BY: - -
- Town Clerk's Office
DATE: _ ..
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