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HomeMy WebLinkAboutPilles 1 ( 8 t Town Hall, 53095 Main Road 00, � P.O. Box 1179 41 $ 00 Southold,New York 11971 JUDITH T.TERRY TELEPHONE TOWN CLERK (516) 765-1801 REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 794-R Residential X Non-Residential Fee $ 10. 00 Septic Cesspool X New Existing X Name Of Owner PILLES, RICHARD S. Mailing Address 1 75 BREITSTADT COURT Mailing Address 2 City St Zip SOUTHOLD NY 11971-0000 Property Address 1 75 BREITSTADT COURT Property Address 2 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 516-765-3165 Tax Map No. section 70. 00 block 9 lot 23 .000 Cross Street CLEARVIEW AVENUE Date Of Last Pump Out 0/00/00 Issue Date: 8/19/88 Judith T. Terry Southold Town Clerk (TOWN SEAL) ' t IS "I. Ot F(C OF THE TOWN CLERK c. FUL-C' Town of Southold A Application No. Judith T. Terry, Town Clerk �� s', h, =� y Town Hall, 53095 Main Road s ev; 7 Residential P. O. Box 1179tt5At, Non-Residential Southold, New York 11971O0 f4? ' 0*�f Telephone (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ /Q DATE 4c46. /0, /Fed' OWNER NAME: � tcA( j s, Rt[ es- OWNER MAILING ADDRESS: 75 ErEiTsf ,cL4 C* EOLL -" -to [ , 1�� 1/7 71 OWNER PROPERTY ADDRESS: OWNER TELEPHONE NUMBER: 746 — ,3/ S" TAX MAP NO. : SectionOm,• cteid Re Block Lot /1 CROSS STREET: C(eck,cv4v TYPE OF SYSTEM: Septic Tank New Existing Cesspool ✓ New Existing A✓ Residential Non-Residential DATE OF PREVIOUS PUMP-OUT: Alma t 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 Applicant RECEIVED BY: 471 a , Cr k's Office! 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