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HomeMy WebLinkAboutSchwerdt • OFFICE OF THE TOWN CLERK ' •%IFO(K Town of Southold Judith T. Terry, Town Clerk . r Town Hall, 53095 Main Road • P. O. Box 1179 ;v' ; i �• Southold, New York 11971 4 u 0 �, Telephone _ ire sN (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 9 Residential XXX Fee $ 10 . 00 Non-Residential Septic Cesspool XXX - NAME OF OWNER: Harold P . Schwerdt OWNER MAILING ADDRESS: 2720 Cedar Avneue Southold , New York 11971 OWNER PROPERTY ADDRESS: same OWNER TELEPHONE NUMBER: 765-5561r TA TAX MAP NO. : Section 077 Block 02 Lot n1 ' CROSS STREET: Oak Avenue TYPE OF SYSTEM: Septic Tank New Existing Cesspool XXX New Existing XXX • Residential XxX Non-Residential DATE OF' PREVIOUS PUMP-OUT: 10 years ago 1.001, Judi fel. T / Southold Town Cler'fc DATE: Augsut 1-5 , 19Rh (TOWN SEAL) OFFICE OF THE TOWN CLERK oFD(,r - Town of Southold �o , = CG' • Application No. Judith T. Terry, Town Clerk . Town Hall, 53095 Main Road • �C l Residential P. O. Box 1179 Non-Residential eao ` � rte- Southold, New York 11971 O ® • $ Telephone (41 1'44 • (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ • DATE g// q11 E4 J ( OWNER NAME: r t1 f;'���� �,� AAA LG,& /A Il) 1,/�/JEi.' J t OWNER MAILING ADDRESS: v2 12 b.i A a /L° :, 1 f-9 Lb/ Al° , ` / ! S7l / f OWNER PROPERTY ADDRESS:_ OWNER TELEPHONE NUMBER: 7,45 d; 6 TAX MAP NO. : Section e 7 .7 Block 61A Lot a ,/ CROSS STREET: /)/( TYPE OF SYSTEM: Septic Tank New Existing Cesspool � New Existing Residential Non-Residential DATE OF PREVIOUS PUMP-OUT: 7 I h � r$ 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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