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HomeMy WebLinkAboutRapp OFFICE OF THE TOWN CLERK • '0FO[/f(C,i Town of Southold - Q Judith T. Terry, Town Clerk " Town Hall,. 53095 Main Road t ' - P. O. Box 1179' �� ` Southold, New York 11971 ' Telephone O .V (516) 765-1801 ' TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 412 Residential x Fee $ 10.00 Non-Residential Septic Cesspool x NAME OF OWNER: Kenneth J. and Eleanor K. Rapp OWNER MAILING ADDRESS: Rd 1,Box 113 Stamford, New York 12167 OWNER PROPERTY ADDRESS: Lake Drive, Reydon Shores Southold, New York ' OWNER TELEPHONE NUMBER: 607-652-7205 516-765-3072 TAX MAP NO. : Section 80 Block 3 Lot 16 CROSS STREET: Grove Drive TYPE OF SYSTEM: Septic Tank New Existing Cesspool, X New Existing X Residential X Non-Residential DATE OF PREVIOUS PUMP-OUT: June 1987 T_ Torry Southold Town Clerk DATE: August 24, 1987 (TOWN SEAL) - OFFICE OF THE TOWN CLERK cOFIl(,r'= Town of Southold CSG • Application No. �`2' Judith T. Terry, Town Clerk ,` w ` Town Hall, 53095 Main Road 53' # �.r Residential P. O. Box 1179 �� ' �:' Non-Residential Southold, New York 11971 ® �` Telephone = i.� (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK :or CESSPOOL Operation Permit No. Fee $ 7©, 0 DATEMAt- 21141? OWNER NAME: ko141'vve 1/ cJ n �GC�/9.voizi 7< �� D/a OWNER MAILING ADDRESS: e gox-' )/..3 /-- ///,p2/ 7 OWNER PROPERTY ADDRESS: 4,1[4t_ 1i/l/VL1C- (\14-ze- sen,JR--Z, AI ty, OWNER TELEPHONE NUMBER: 667-6S-2-'- 7 ' S— 36 7 '2— TAX TAX MAP NO. : Section tO Block 3 Lot CROSS STREET: TYPE OF SYSTEM: Septic Tank New Existing Cesspool New Existing Residential '/ Non-Residential r q DATE OF PREVIOUS PUMP-OUT: v fAAA-14- ) 9 Y 7 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.) Signatur of Ap kelt RECEIVED BY: gAl Town Cl . k's Off ce DATE: (�l'�(t a� /9 r7 �o •L ery o /� ©2 adv