HomeMy WebLinkAboutSchwarting _,,
JUDITH T.TERRY 4 el • Town Hall, 53095 Main Road
TOWN CLERK ; P.O. Box 1179
�� Southold,New York 11971
REGISTRAR OF VITAL STATISTICS
�� Fax(516) 765-1823
MARRIAGE OFFICER sj� ®���
RECORDS MANAGEMENT OFFICER : ®1 4:111. Fax
(516) 765-1800
FREEDOM OF INFORMATION OFFICER �,,,,�•���
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3546-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner SCHWARTINC, CHRISTOPHER
Mailing Address 1 P. O. BOX 636
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 3825 SOUTH HARBOR ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-3126
Tax Map No. section 78.00 block 3 lot 10.000
Cross Street HIAWATHA'S PATH
Issue Date: 11/15/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
• • ���
OFFICE.OF THE TOWN CLERK •COFU -
Town of SoutholdCQ4. �=,\ Application No.-36
Judith T. Terry, Town Clerk �)
Town Hall, 53095 Main Road ! ,�fct $10.00 - Residential
-4-
P. 0. Box 1179 cry 4 `".: $25.00 - Non-Residential
New York 11971 4 ® ? N `�
Southold, pal �o�,���
Tele hone44
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT " _ _
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ 1.0 .
DATE o.:l. : I'"?, 15 5
OWNER NAME: 0-V2,;S O\-,7Ia Fes. ScAA
OWNER MAILING ADDRESS: C3 (-5�)C
• �� 1454-1
OWNER PROPERTY ADDRESS : 3s 25 Som o-pat, ,2... �>
•tea (c01°� N '-/
OWNER TELEPHONE NUMBER: 7(.,5_ 312,6
TAX MAP NO. : Section I x -7 Block , Lot 13
CROSS STREET: ),A I/�Wp�rO�gi� Qni1-4- _
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Z./ Non-Residential
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 piicant
RECEIVED BY:
Town Clerk's Office
DATE:
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