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HomeMy WebLinkAboutOlmsted 1-e) �61f4�,t U t�V9� 1� 4 ' Town Hall, 53095 Main Road P.O. Box 1179 - i ;t'. � Southold, New York 11971 JUDITH T.TERRY `-. il� TELEPHONE TOWN CLERK ���� , (516) 765-1801 REGISTRAR OH VITAL STATISTICS OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 876-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner OLMSTED, ROBERT AND SIDNY Mailing Address 1 BOX 436 Mailing Address 2 City St Zip MATTITUCK NY 11952-0000 Property Address 1 1240 WESTPHALIA ROAD Property Address 2 City St Zip MATTITUCK NY 11952-0000 Owner Telephone No. 516-298-4945 Tax Map No. section 114.00 block 7 lot 14.000 Cross Street - COUNTY ROAD 48 Date Of Last Pump Out 0/00/00 Issue Date: 10/06/88 Judith T. Terry Southold Town Clerk (TOWN SEAL) • as to, OFFICE OF THE TOWN CLERK c�V� � � Town of Southold , Q C�G Application No. 3s-72Judith T. Terry, Town Clerk y r/ Town Hall,- 53095 Main Road ��, Residential V® t :•p. .0. Box 1179 � ���4�� {� � �i ;` Non-Residential Southold, .New York 11971W` Ot� �0���` ,. _Telephone �i- • (516) 765:1801 1 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION - _ -- - - for OPERATIONPERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ /d4 DATE ®1 / 3 / /ttl- OWNER NAME: Oifra J�� A `l-T" d- OWNER MAILING ADDRESS: J3 © 6/ 3 & , .%/./, ) / JS2 OWNER PROPERTY ADDRESS: / R1/0 IA/-s f/74 //A fl d /1" (/ / 1 a OWNER TELEPHONE NUMBER: TAX MAP NO. : Section / / (1 Block '- `-7-' Lot / k, // �" . - CROSS STREET: .t/ ! TYPE OF SYSTEM:r Septic Tank X New Existing __ ' Cesspool X New Existing I . Residential Non-Residential i 't " DATE OF PREVIOUS:PUMP-OUT: //i/ k/i/tpi.v,/ LOCATION MAP: Must be attached hereto before permit may be issued (Locate building and system; givenorth arrow and feet of distance, approximately, to building and closest r\oa'd.) Adi CEJ (, 1Si nature of Applic.nt RECEIVED BY:' t,:'o ui C rk's Office , DATE: n T o 1988 ' ' 09etk So +ord � � ccclll CJ • G (i° Gb� 2ov