HomeMy WebLinkAboutSheren OFFICE OF THE TOWN CLERK c FEJ[
Town of Southold
Judith T. Terry, Town Clerk ��g
Town Hall, 53095 Main Road . • ,S,
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P. O. Box 1179 cn ';irk: -f
Southold, New York 11971 �w� t .
Telephone �,{ *
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation_ Permit No. 572 Residential X
Non-Residential
Fee $ 10.00 Septic x Cesspool
NAME OF OWNER: Harry and Grace Sheren
OWNER MAILING ADDRESS: 129-A Saltaire Way
Mattituck, New York 11952
OWNER PROPERTY ADDRESS: 129-A Saltaire Way
Mattituck, New York
OWNER TELEPHONE NUMBER: 516-298-4878
TAX MAP NO. : Section 100 Block 1 Lot 33
CROSS STREET: Soundview Avenue
TYPE OF SYSTEM: Septic Tank X New Existing x
Cesspool New Existing
Residential x Non-Residential
DATE OF PREVIOUS PUMP-OUT: 12-22-86 _
'1"'-•t h T.• `-
Southold Town clerk
DATE: Janaury 11-, 1988 V
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(TOWN SEAL)
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OFFICE OF THE TOWN CLERK �5\\FF0(,-�'=
Town of Southold Oho CQG' , , Application No. 3 7�
Judith T. Terry, Town Clerk
.�, ��. . I Residential c.2.----
Town
Hall, 53095 Main Road c ; -, . -
P. O. Box 1179 cn W 00•' ' Z Non-Residential
Southold, New York 11971 O '� *01 $
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Telephone :�( • '.
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
•
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 617
Fee $ 1 0•
. DATE /07/d
OWNER NAME: /�%et- �/�.i1�c 4---z9E�
OWNER MAILING ADDRESS: /e,.2,:-„, c.S,.<JC7;r4,/€e Gt/,
/e-1TT/%ucA. /1J y //f_S
OWNER PROPERTY ADDRESS: c,.r�- /
OWNER TELEPHONE NUMBER: 57.6 bpd 'f7f
/L-f4,',,,/5 4t r-4-i-''f ,e'�7:fi eS /4/4,0 Y'I2 �}�
TAX MAP NO. : Section /4 Block / Lot 33
CROSS STREET: ,f._,..,.,✓ l/ts'c.✓
TYPE OF SYSTEM: Septic Tank C.------- New Existing
Cesspool New Existing .-r,T
Residential /1.--'" Non-Residential
-- DATE OF PREVIOUS PUMP-OUT: /QZ�r71/r6
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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9 Sign ur-of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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,. SUFFOLK COUNTY HEALTH DEPARTMENT
D.,iE .SUN 1914 H. D. REF. vF •�� _�� �� 6"
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T in sewage disposal and water :supply
• ,'JO - i,••cilit Lus for this location have been
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RFlIISIONS YOUNG Sc YOUNG
FEB 1,1974 400 OSTRANUER AVENUE, RRERHEAD, NEW YORK
. APRt_25,1974 1
ALDEN W. YOUNG HOWARD W. YOUNG 9
Y NOFESSILTNAL ENL:INhER AND LAND SURVEYOR
LAND SURVI YUR. N Y S. L.IC NC). I2S43 N Y S LIC NO. 45e9
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SURVEY FOR:
..fu,Tr.,,Ni2W 4 't HA7101. ON AOI; IInN TOIHARRY SHEREN Ba GRACE SHE:REN
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