HomeMy WebLinkAboutVan Holthe OFFICE OF THE TOWN CLERK • ci\ FO
Town of Southold � �Cc•
Judith T. Terry, Town Clerk
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Town Hall, 53095 Main Road �'`
P. O. Box 1179 iEn ?.z g:
Southold, New York 11971 O " '" ••
Telephone Ol Nye V> . •
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 455 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool X
NAME OF OWNER: Edward Van Holthe
OWNER MAILING ADDRESS: P.O. Box 549
Southold, New York 11971
OWNER PROPERTY ADDRESS: Main Road (Apartment located above Lynorette)
Southold, New York 11971
OWNER TELEPHONE NUMBER:. 516-765-2585
TAX MAP NO. : Section 62 Block 1 Lot 4
CROSS STREET: Maple Lane
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Approximately 2 years aqo'. -}1985
Judith rry
Southold Town Clerk
DATE: October 8, 1987
(TOWN, SEAL,)
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OFFICE OF THE TOWN CLERK is
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Town of Southold •® w C&, Application No/-4.5-5—
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Judith T. Terry, Town Clerk ' sem; , •`
Town Hall, 53095 Main Road =s :'� ` Residential
P. O. Box 1179 cnf `� i Non-Residential
Southold, New York 11971 '(Z4 _,r_ �`�
Telephone o.( 0.\-"/p "
RICEIl4E®516) 765-1801
OCT 0 2 1987 TOWN OF SOUTHOLD
•
Toon Cterlc Southold SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ 10
DATE
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OWNER NAME: E, Hcy
OWNER MAILING ADDRESS: (-0.0. R 0% 514,'
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OWNER PROPERTY ADDRESS i y% ;, ‘e,j,,,or _
OWNER TELEPHONE NUMBER: 7hc;^-
cc‘oe'' TAX MAP NO. : Section 6 2i Block / Lot `7"
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CROSS STREET: 7'72-
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TYPE OF SYSTEM: Septic Tank ,( New Existing
Cesspool New Existing
Residential Non-Residential
--- DATE OF PREVIOUS PUMP-OUT: Qoow"r 2, `erS 4a.rn
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LOCATION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow and feet
?lf'^"' of distance, approximately, to building and closest road.)
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signature of Applic
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RECEIVED BY: "
own jerk's ffice�
DATE: 70 -- 7 a -7
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