HomeMy WebLinkAboutTempel OFFICE OF THE TOWN CLERKFU�C�
Town of Southold ���
Judith T. Terry, Town Clerk ` P y
Town Hall, 53095 Main Road a '
P. O. Box 1179 j4' ;` , ';r •
Southold, New York 11971 =Q:_` Off- •�
Telephone = 01 4t •
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 256 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool X
NAME OF OWNER: Ernest H. Tempel
OWNER MAILING ADDRESS: 865 Founders ,Path
Southold, New YOrk 11971
OWNER PROPERTY ADDRESS: 865 Founders Path
Southold, New York
OWNER TELEPHONE NUMBER: 516-765-2114
TAX MAP NO. : Section 64 Block 2 Lot 41
CROSS STREET: Landon Lane
TYPE OF SYSTEM: Septic Tank New - Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: January 1987
Judith T. Terre
Southold Town Clerk
DATE: April 7, 1987
- ` (TOWN SEAL)
OFFICE OF THE TOWN CLERK c�vFFO(� - _
Town of Southold � r C'Q ;, Application No. �-5 6
Judith T. Terry, Town Clerk ` * •
Town Hall, 53095 Main Road " ) Residential
P. O. Box 1179 u' ri
i ;' Non-Residential
Southold, New York 11971 Ow `�
Telephone
(516) 765-1801 1
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /b
DATE 3 - o-) 7
OWNER NAME: , ,fc/ c5 1 Hi1.470)47--
OWNER
,t /._.
OWNER MAILING ADDRESS: ne(5 ) ,7"
. � , . 77f
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: 7L5------ 12�
TAX MAP NO. : Section to Block ot Lot r
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool f/ New Existing !�
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: ije /
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.)
Signature of App ' ant
RECEIVED BY: .e..-
RECEIVED Town Clerk's ffice
DATE: Mbin a it
Toi' rAP.rF Southold
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