HomeMy WebLinkAboutMehl OFFICE OF THE TOWN CLERK 6 'cOFIRA'r"
Town of Southold �, �
Judith T. Terry, Town Clerk Z n � t � ":r, -
Town Hall, 53095 Main Road o ;" j», ,
P. O. Box 1179
Southold, New York 11971 \ �O-.® z" ' ��- !�
Telephone ��
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation. Permit No. 600 Residential x
Non-Residential
Fee $ 10.00 "
Septic Cesspool x
NAME OF OWNER: Mrs. Gertrude Mehl
OWNER MAILING ADDRESS: 1970 Skunk Lane
Cutchoque, New York 11935
OWNER PROPERTY ADDRESS: 1970 Skunk Lane
Cutchogue, New York 11935
OWNER TELEPHONE NUMBER: 516-734-6728
TAX MAP NO. : Section 97 Block- 3 Lot
CROSS STREET: Main Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown " •
•
-Judith T.T
Southold Town Clerk
DATE: February. 11, 1988 - -
(TOWN SEAL)
/I IIS
OFFICE OF THE TOWN CLERK o5OF0(,'/�'-
Town of Southold Application No.(po d
Judith T. Terry, Town Clerk . .w-47 •
Town Hall, 53095 Main Road =.-.:`f "' ''� ` Residential
P. O. Box 1179 u' A , i Non-Residential
Southold, New York 11971 v.O a4"4- ,'off'`,
•
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLI CAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ _,/eye
DATE /'-eR7-- �
OWNER NAME: M 1r)19 , ge frt Mi
OWNER MAILING ADDRESS: W.--2 1 ) 7o v9 Lt," 117 k
C�s�GAc� -r�� 7)04 // 3`S
OWNER PROPERTY ADDRESS: / 6-re
OWNER TELEPHONE NUMBER: " "'
/or IP
TAX MAP NO. : Section 9-7 Block 5 Lot l S
CROSS STREET: 19%6 ip
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool � New Existing
Residential Non-Residential
- DATE OF PREVIOUS PUMP-OUT: (14/1 _r5"/A1
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: G �,
Town C Xerk's ffice
DATE: c:29////t,
, ..---
,\I
—_____--•,-,,1=-- -
,
) ,-
.
) f
0
." r i
f. ip..raiAll fir
IN .,
4 1 10
(
1.-- •
CVID--
1 )
0 i i
# I
Sara \ \
t rub-,
Cp
3 it ii t...,, ,.._.........,...
,
,
io 70 ........,
....