HomeMy WebLinkAboutReinOFFICE OF THE TOWN CLERK
Town of Southold
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road
P. 0. Box 1179
Southold, New York 11971
Telephone
(516) 765-1801
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 589
Fee $ 10.00
NAME OF OWNER: Hans Rei
Residential X
Non -Residential
Septic Cesspool X
OWNER MAILING ADDRESS: 723 Hempstead Avenue
West Hempstead New York 11552
OWNER PROPERTY ADDRESS: 550 Knollwood Lane
Mattituck New York 11952
OWNER TELEPHONE NUMBER: 516-486-8103
TAX MAP NO.: Section 107 Block 1 Lot 17
CROSS STREET: Grand Avenue
TYPE OF SYSTEM: Septic Tank
New
Cesspool X New
Existing
Existing X
Residential X Non -Residential
DATE OF PREVIOUS PUMP -OUT: Unknown
DATE: January 27, 1988
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Judith T. TeWry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK
Town of Southold
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road-
P.
oadP. -0. Box 1179
Southold, New York 11971
Telephone
(516). 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
JAN 2 ® 1967 APPLICATION
Town rjerk Southold _for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
OWNER NAME:
OWNER MAILING ADDRESS;
Application No.6-g%
Residential A, -
Non -Residential Non -Residential
DATE`
OWNER PROPERTY ADDRESS: SILI �7 c-ip�C11/_�'_
OWNER TELEPHONE NUMBER:
TAX MAP NO.: Section -7 Block / Lot
CROSS STREET: rd, L
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing X
Residential Non -Residential
DATE OF PREVIOUS PUMP -OUT:
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.)
Signat re of Applicant
RECEIVED BY: Z64ac-'=
n `Clerk's Office
RECEliffi
DATE
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