HomeMy WebLinkAboutPrellwitz OFFICE OF THE TOWN CLERK • Fa
Town of Southold , 0�05�� C��
Judith T. Terry, Town Clerk y/Vi %t %%
Town Hall, 53095 Main Road
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P. O. Box 1179 1�� �-:•� � •
Southold, New York 11971 p
Telephone �- 0,( afin
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 469 Residential x
Non-Residential
Fee $ 10.00
Septic Cesspool X
NAME OF OWNER: Samuel B. Prellwitz
OWNER MAILING ADDRESS: 947 LaClair Avenue
Pittsburgh, PA 15218
OWNER PROPERTY ADDRESS: Indian Neck Lane
Peconic, New York
OWNER TELEPHONE NUMBER: 412-243-8192
TAX MAP NO. : Section 86 Block 7 Lot 7.1
CROSS STREET: Robinson Lane
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
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Judith T. rry
Southold Town Clerk
DATE: October 19, 1987
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK FD(,,'
Town of Southold �� - CQ ' , Application No.
Judith T. Terry, Town Clerk'. ,, ��
Town Hall, 53095 Main Road ' ` Residential
P. O. Box 1179 cn sy0, % Non-Residential
Southold, New York 11971 O Q " e $
Telephone - --f'9.1
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ ‘0 400
DATE Oct. 1, 1987
OWNER NAME: Samuel B. Prellwitz
OWNER MAILING ADDRESS: 947' LaClair Avenue
Pittsburgh, PA 1 571 8
OWNER PROPERTY ADDRESS: Indian Neck Lane
Peconic, NY 11958
OWNER TELEPHONE NUMBER: (412) 243-8192
TAX MAP NO. : - Section 1000-86-7.7 Block -� Lot
CROSS STREET: Indian Neck Lane
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool xx New Existing XX
Residential XX Non-Residential
- DATE OF PREVIOUS PUMP-OUT: Aug. 6, 1987
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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Signature of Applican
RECEIVED BY:
Town Clerk's Office
DATE: