HomeMy WebLinkAboutRasweiler � � t
Town Hall, 53095 Main Road
P.O. Box 1179
" Southold, New York 11971
JUDITH T.TERRY FAX(516)765-1823
TOWN CLERK TELEPHONE(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. 1462-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner RASWEILER, JOHN J. III
Mailing Address 1 P. O. BOX 1032
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 ROW (HORSESHOE ROAD)
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-6611
Tax Map No. section 111 .00 block 5 lot 8.000
Cross Street VANSTON ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 5/17/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFI 'E OFA- THE TOWN CLERK •0
Town of Southold %- --�(�`,�
Off. OG'_ Application No. /4/6
Judith T. Terry, Town Clerk :; s r
Town Hall, 53095 Main Road ' �;' ::-.4.4 %) $10.00 - Residential
P. 0. Box 1179 / -54-#41. ?.1!.1,...`,i,
Y� k
V. '�irr'.L'r .
� �- t ���-� ` ��� $25.00 - Non-Residential
Southold, New York 11971 O�`:� ., O���� •
Telephone _Q( ��• .
(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: �1 (2l,
•
OWNER MAILING ADDRESS: z e •
-,Qa)4 sdo-exu.a.,40,c Ad5
OWNER PROPERTY ADDRESS: f -V 'KA_
Vi ,V, LVt3S
OWNER TELEPHONE NUMBER: 5V/ L- -73 ' •- k 1L
.
TAX MAP NO. : Section /// Block 5- Lot
•
CROSS STREET: -T/G. ,,,,� ,
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing L__
Residential /...---"-----
/ Non-Residential
DATE OF PREVIOUS PUMP-OUT: .$/1,1 150 -- S /ifs. „Q�,
LOCATION MAP: Must be attached hereto before permit may be iss ed.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest :oad.)
Si nature of Applicant
RECEIVED BY:
• fiTlerk's Office
DATE: DAY 17199U - -
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SURVEYED FOR i
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