HomeMy WebLinkAboutNintzel OFFICE OF THE TOWN CLERK • • FO[x`,D
Town of Southold 1 ����Ft
Judith T. Terry, Town Clerk ' _- y
Town Hall, 53095 Main Road
P. O. Box 1179 to t` -
Southold, New York 11971 - Q,y� s •�,
Telephone 1 4[
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 260-1 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool X
NAME OF OWNER: George Nintzel
OWNER MAILING ADDRESS: P.O. Box 253
Cutchoque, New York 11935
OWNER PROPERTY ADDRESS: 60 West Road
Cutchogue, New YOrk
OWNER TELEPHONE NUMBER: 516-734-5354
TAX MAP NO. : Section 110 Block 5 Lot 36
CROSS STREET: Pequash Avenue and West Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool - X • New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Never previously pumped
Judith T. Terr
Southold Town Clerk
- r
DATE: April 7, 1987
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK S�FFDC,(CQG
Town of Southold �� _ _ ' , Application No.
Judith T. Terry, Town Clerk �� ;;' y
Town Hall, 53095 Main Road ® Residential
P. O. Box 1179 c' ` ' • Non-Residential
Southold, New York 11971 O ®_ �`
Telephone _ .�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
° Fee $ •
DATE I. 1 9
OWNER NAME: C-:; i l- E. NI ,JTzJ-
OWNER
MAILING ADDRESS: P.o . go ,/ 053
Cul-611090e J N-eu) )l 5 3s—
OWNER
sOWNER PROPERTY ADDRESS: (0 0 Lu 2 ST d
C°u$chD5ye, JJQ,0,) /o Pic llI3S
OWNER TELEPHONE NUMBER: 7 5 3 5•V-
TAX MAP NO. : Section 910 Block 5— Lot 3I
CROSS STREET: u(Q S h 0 U'l_ 4 Ltjo 2_0coL-
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential t Non-Residential
DATE OF PREVIOUS PUMP-OUT: L-721-UW
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.)
(
Si. `ature of Apv icant
RECEIVED BY:
Town Clerk's Office ,
DATE:
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