HomeMy WebLinkAboutSpielman 411 mu(
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Town Hall, 53095 Main Road
� � �' P.O. Box 1179
�Po"' Southold, New York 11971
JUDITH T.TERRY •,di FAX(516)765-1823
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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. 1459-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner SPIELMAN, STEVEN AND BEVERLY
Mailing Address 1 2540 BRIDGE LANE
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 2540 BRIDGE LANE
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 212-744-4356
Tax Map No. section 85.00 block 2 lot 23.000
Cross Street MAIN ROAD AND ROUTE 48
Date Of Last Pump Out 0/00/00
Issue Date: 5/15/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE'"GF THE TOWN CLERK 1c�\\FFUL '
Town of Southold C'
;y� � OG ;• Application No./ S9
Judith T. Terry, Town Clerk fx ` $10.00 - Residential
Town Hall, 53095 Main Road t ' •
P. O. Box 1179 cry e i ` $25.00 - Non-Residential
Southold, New York 11971 4 "® asa;'a
Telephone a `A% ..
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
•
for
• OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /0 6e40-1.-c
DATE Vna /qo
11 n
OWNER NAME: 1 -6..)e,C) -'t ?-)e_Qe4 l S 1e � •
•
OWNER MAILING ADDRESS: QS- f0 3t ( r( e Lir e
N
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: .21,1 744 43 a 5/i 73 -7
TAX MAP NO. : Section (Z5 Block Lot 23
CROSS STREET: '1At,� � 3a,A,1) 49 40
I
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool / New Existing
Residential V Non-Residential
DATE OF PREVIOUS PUMP-OUT: Ne.i3e.A/
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.)
j(4.04,1, L-Sivvt,
Si nature of Applicant
RECEIVED BY: ce_ �
Town/Clerk's Office_ _ - _ ,•
DATE: 'EMP RMd1113
MAY 1 d . MY Nit)
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