HomeMy WebLinkAboutPomerantz OFFICE OF THE TOWN CLERK • � ,'rt r�+
Town of Southold �O Ob
Judith T. Terry, Town Clerk .�"r ,
Town Hall, 53095 Main Road cn
P. O. Box 1179
Southold, New York 11971 \ p ��� t� �Telephone t
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation. Permit No. 553 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: Samuel Pomerantz
OWNER MAILING ADDRESS: 331 West 19th Street
New York, New York 10011
OWNER PROPERTY 'ADDRESS: 631 Bayshore Road
Greenport, New York 11944
OWNER TELEPHONE NUMBER: 212-929-0956 -
TAX MAP NO. : Section 53 Block 4 Lot
CROSS STREET: Kerwin Blvd.
TYPE OF SYSTEM: Septic Tank X New Existing x
Cesspool New Existing
Residential x Non-Residential
DATE OF PREVIOUS PUMP-OUT: 1982
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Ju rt e
'Southold Town lerk
DATE: December 29, 1987
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK -`51FUUr
Town of Southold0�� Application No. 3' `3
Judith T. Terry, Town Clerk �►
Town Hall, 53095 Main Road Residential
P. 0. Box 1179 cn i f 'moi��' Non-Residential
Southold, New York 11971 ,(71;4,141.1f--
Telephone
(516) .765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE
OWNER NAME: S(O U t(, 460 -r7--
OWNER MAILING ADDRESS: '6'3 ) a 4xt.ci-fall U` Q
OWNER PROPERTY ADDRESS:
f9Q
OWNER TELEPHONE NUMB R: /166/ . C1 toOII
- J r ✓ 0
TAX MAP NO. : Section S-J3 Block T Lot
CROSS STREET:
TYPE OF SYSTEM: Septic Tank v New Existing
Cesspool New Existing
Residential Cr Non-Residential
DATE OF PREVIOUS PUMP-OUT: 19
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.)
Signa ure o Applicant
RECEIVED BY:
R.ECE9vE15own C rk's Off ce
DATE: DE 2 9 `9'x'1
Town Clark Southold
Samuel Pom rantz
331 West 19th Street
Ne.0 York, N. Y. 10011
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