HomeMy WebLinkAboutStern OFFICE OF THE TOWN CLERK "' °cwFFU(irt;' ---
Town of Southold �
Judith T. Terry, Town Clerk ;;;74 -4,..-.:
Town Hall, 53095 Main Road
P. O. Box 1179 En �T
Southold, New York 11971 5Z!(
Telephone Ix' [
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 101 Residential XX
Fee $ 10.00 Non-Residential
Septic Cesspool XX
NAME OF OWNER: Albert D. Stern
OWNER MAILING ADDRESS: Box 231
Mattituck, New York 11952
OWNER PROPERTY ADDRESS: 620 Meday Avenue
Mattituck, New York
OWNER TELEPHONE NUMBER: 516-298-8189
TAX MAP NO. : Section 113 Block 10 Lot 10
CROSS STREET: Illinois Avenue
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool XX New Existing XX
Residential XX Non-Residential
DATE OF PREVIOUS PUMP-OUT: 1971
Judith T. Terry
Southold Town Clerk
DATE: October 20. 1986
( (TOWN SEAL) •
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OFFICE OF THE TOWN CLERK - 'c3\SVFO(K
Town of Southold �� .. Application No. /0
Judith T. Terry, Town Clerk � _ ,k. t) Residential
Town Hall, 53095 Main Road
P. O. Box 1179 c
E% Non-Residential
n �� �� '} �
Southold, New York 11971 �yA-® �0 ,�`
Telephone =o.( ,
(516) 765-1801
RECEIVED TOWN OF SOUTHOLD
OCT 2 0 1986 SOUTHOLD WASTEWATER DISPOSAL DISTRICT
"'from NAr'( Southold
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No./67
id
Fee
$ e)1" .'
DATE /0/06
OWNER NAME: A L /3,e ✓ rri(y Are
OWNER MAILING ADDRESS: 136 , /144717'`) re/1 !
OWNER PROPERTY ADDRESS: 6 °1-4 iD 47 Avg
OWNER TELEPHONE NUMBER: 9 t® t' 8
.9
/8..,. .,6
TAX MAP NO. : Section ! Block Lot
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: / 9°?/
LOCATION MAP: Must be attached hereto before permit may be issued.
Ne.. (Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
® Signature of Applicant
f��INIDIs /* Vi
RECEIVED BY: 2 � Q
Town erk's O fice
DATE: , /2eft-
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