HomeMy WebLinkAboutSchwab 1114' r
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Town Hall, 53095 Main Road
�� P.O. Box 1179
_ �1� ft®�tISouthold, New York 11971
~ ®� FAX(516)765 1823
JUDITH T.TERRY „
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. 1107-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner SCHWAB, GEORGE L.
Mailing Address 1 P. O. BOX 96
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 2300 PINE NECK ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-1388
Tax Map No. section 70.00 block 9 lot 7.000
Cross Street OAKLAWN AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 5/11/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK //O7
Town of Southold � Application No.
Judith T. Terry, Town Clerk . y
Town Hall, 53095 Main Road c=3 fra :f}« -4. Residential
P. O. Box 1179 cn `< `'*` -r.is 1-77 - Non-Residential
Southold, New York 11971O ® , e�`
Telephone 0( • %Na-aa
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
•
Fee $/0...012
DATE Vd
OWNER NAME: C Gc%w %'
OWNER MAILING ADDRESS: V(9
/19(
OWNER PROPERTY ADDRESS: ,R3-1.4) (i&-,,, —)1.0,)
OWNER TELEPHONE NUMBER: ?6_,57-1.3 p Y ,
TAX MAP NO. : Section Block Lot
CROSS STREET:
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.)
/MVhat ; of pplic•
RECEIVED BY:
Town Clerk's Office,
DATE:
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