HomeMy WebLinkAboutPluschau OFFICE OF THE TOWN CLERK .c��FFOL `+
Town of Southold ,, 5 r
Judith T. Terry, Town Clerk ,
Town Hall, 53095 Main Road c _ `' `,;•
P. O. Box 1179 A Ln
Southold, New York 11971 O �-
Telephone24(
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 601 Residential X
Non-Residential-
Fee
on-Residential-Fee $ 10.00 Septic Cesspool X
NAME OF OWNER: Raymond W. Pluschau
OWNER MAILING ADDRESS: 5520 Narrow River Road
Orient. New York 11957
OWNER PROPERTY ADDRESS: 5520 Narrow River Road
Orient. New York
OWNER TELEPHONE NUMBER: 516-323-2429
TAX MAP NO. : Section 27 Block 2 Lot
CROSS STREET: Main Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: 19811
•
Judith T. Ty
Southold Town Clerk
DATE: February 11 , 1988
_(TOWN SEAL)
• ...
OFFICE OF THE TOWN CLERK sc�UFF40(/•���
Town of Southold �� . CQ Application No. ' /
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road o Residential ✓
p. O. Box 1179 cry 3 � � � Non-Residential
Southold, New York 11971 ���,��`
Telephone 1
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
or-
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE // -
OWNER NAME: / '/L iveoA13j 1'i1. / /Ge,f /9-/:-(�.
OWNER MAILING ADDRESS: 5-6- a /e`IIJ
o g///L/ r- jV
OWNER PROPERTY ADDRESS: .51c 2 0 /J4 ko L-� �) V1`
41.
OWNER TELEPHONE NUMBER: `3 2 GVH- % ti
TAX MAP NO. : Section 7 Block Lot
vAly
CROSS STREET: n7/9//V /2 7 c 'l
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool (/ New Existing
Residential ,/ Non-Residential
DATE OF PREVIOUS PUMP-OUT: 7-612�
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: wn � f _
Town C rk's O ice
DATE: 02 -// 'cPY
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