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JUDITH T. TERRYTown Hall, 53095 Main Road
TOWN CLERK ® rrP.O. Box 1179
U' Southold, New York 11971
REGISTRAR OF VITAL STATISTICS 1i® '�., �� Fax (516) 765-1823
MARRIAGE OFFICER s,'b e” Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER ®,1 4
FREEDOM OF INFORMATION OFFICER '��� �ii.��
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3157-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner SCHWENKER, EDWARD
Mailing Address 1 555 SMITH DRIVE SOUTH
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 555 SMITH DRIVE SOUTH
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-5370
Tax Map No. section 76.00 block 2 lot 27.000
Cross Street MAIN BAYVIEW ROAD
Issue Date: 12/20/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK c.VFFD(,r�
Town of Southold � CQ ' Application No. 3/ S7
Judith. T. Terry, Town Clerk � *A't, 1 Residen, tial
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T,�,wn Hall, 53095 Main Road � �� _ $10.00 -
P. O. Box 1179 cn � ` ;r' ' ► ; $25.00 - Non-Residential
Southold, New York 11971 O •�
Telephone �_'°1- N 's•
•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /? . /70
• DATE /Ae7� _ l
OWNER NAME: � t I)Pria b ems/
OWNER MAILING ADDRESS: 5- r t' Pe_ ga -
4oci` 6i-A, sl,: /(Q7(
_ OWNER PROPERVI if AD- DRESS': -6/kn't l am ;r: - - - -
OWNER TELEPHONE NUMBER: 1 6-3 7�
4/75 5r T 1 • — '�--�-7
TAX MAP NO. : Section Block Lot
/�
CROSS STREET: /(44/4 / jA-C�
TYPE OF SYSTEM: Septic Tank New Existing
,Cesspool New Existing
Residential V 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.)
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A,e45..e,4.1-e-r—
Sig ure of Applicant
RECEIVED BY: /Town
,
T
own CI rk's Office
DATE:
a(5 a.6 70 q..0 ( _C."51
Mr.Edward X. Schwenk T
, 555 Smith Dr. S
Southold,NY 11971( /
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