HomeMy WebLinkAboutVon eiff OFFICE OF THE TOWN CLERKFU
Town of Southold D%" ._ COQ-
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road `
P. O. Box 1179 to
Southold, New York 11971
Telephone 0d [
(516) 765-1801 •
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 187 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool X ,
NAME OF OWNER: Donald & Joan Von Eiff
OWNER MAILING ADDRESS: 110 Yale Avenue
Oakdale, New YO'rk 11769
' OWNER PROPERTY ADDRESS: 145 Mill Creek Drive
Southold, New York
OWNER TELEPHONE NUMBER: 516-589-4066
TAX MAP NO. : Section 135 Block 3 Lot 25
CROSS STREET: Grove Road •
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: October 14, 1986
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Judith T. Terry
Southold Town Clerk
DATE: December 22, 1986
•
(TOWN SEAL)
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as .
OFFICE OF THE TOWN CLERK 0C��FFQ(�•
Town of Southold Oho CQG Application No. l�
Judith T. Terry, Town Clerk '/
�..� Residential
Town Hall, 53095 Main Road • 'rt?
P. O. Box 1179 cn V V.V Non-Residential
Southold, New York 11971 $3;''
Telephone _01 • ..
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 10
Fee $ f0 2
DATE Pec, /8, /? 7
OWNER NAME: -Do,nald OouY) YD1) i icF
OWNER MAILING ADDRESS: no 4ve
nr k c1a_le j 1J'Y, 1171oq
OWNER PROPERTY ADDRESS: 124.5 mit reek-Drive_
�c�u+bold iJ V 1 /q7 /
OWNER TELEPHONE NUMBER: 5,99 - 4.0 (,,(o
x PGrce/ /c O -135- 3 -zr-
TAX MAP NO. : Section Block Lot
CROSS STREET: G/Z0r/2 Ec,ced
TYPE OF SYSTEM: Septic Tank New Existing
/
Cesspool �1/ New Existing 1/7-
Residential
Residential V Non-Residential
DATE OF PREVIOUS PUMP-OUT: 101/4h0
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.)
,>
gnature of Applic
V
RECEIVED BY:
RECEDV25 Town Co rk's O Fice
DATE: DEC 22 1996
Town Clark Southold
NA',11�:a!i{C ALTf:Afir•N t`1 _I I -
THIS SLTV O: ♦L.'TIQti rJ 1 - •
_ EY Is VICIAiION OF
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CTION 7209 Of THE NOV YORK STATE
•'JCATfON LAW. (', {
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`i'!ES OF THIS SURVEY MAP NOT BARING .` - - -
- LAND SURVEYOR'S IN; f - - -
ossp SEAL SHALL NST SE CONSIDERED SI - •r
BE A VALID TRUE CONSICERED t• II.
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r TO Thi D f:fcF?N SHAH RUN - ^_l - - -
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