HomeMy WebLinkAboutShand OFFICE OF THE TOWN CLERK ' FO
Town of Southold ' �� �G
Judith T. Terry, Town Clerk Z ,:N,„
Town Hall, 53095 Main Road
P. O. Box 1179 y�
Southold, New York 11971 Q � J
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 136 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool X
NAME OF OWNER: Ian M. R. and Dena L. Shand
OWNER MAILING ADDRESS: 89 Joralemon Street
Brooklyn .H`dights, New York 11201
OWNER PROPERTY ADDRESS: 1460 North Oakwood Road
Laurel, New York
OWNER TELEPHONE NUMBER: 718-624-0090 516-298-4182
TAX MAP NO. : Section 127 Block 6 Lot 11
CROSS STREET: Peconic Bay Blvd.
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
.004
Judith T. Ter
Southold Town Clerk
DATE: November 10, 1986
(TOWN SEAL) •
OFFICE OF THE TOWNS CLERK cVFFD(,r�"`
Town of Southold �® %. Application No. /3j
Judith T. Terry, Town Clerk % 1" .64 ')
Residential
53095 Main Road
Town Hall,P. O. Box 1179
`)P.'
Non-Residential
Southold, New York 11971 O �.
Telephone •
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
NOV 1019:i APPLICATION
low WO = for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. ic.Y
Fee $ ( ot.D'
DATE H �
OWNER NAME: JAM ! "l t p ` - D E A L , HAILIP
OWNER MAILING ADDRESS: 8cl ,..aP LL-`71-D & sr,
6 00 Lytv /p-fl�, /Ud�'- l��—o (
OWNER PROPERTY ADDRESS: / (716, O /Uo!` 1f 7 01111\--WOOD ,E
b9u_1- L 1N -Y. fl1 (g
OWNER TELEPHONE NUMBER: —.7 (c-- 6 &(9 [ () 5/4 -07/g- ci,/ Z
TAX MAP NO. : Section I ,d 7 Block O 6 Lot ® t/
CROSS STREET: AJZ-ttiA-ALC) 80-1 3 J---04
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.)
Y6L('--4
Signature of Applicant
RECEIVED BY: -v)Lctr,� C )-.
Town C rk's- O fice
DATE: a_ , 10 , (i,,
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