HomeMy WebLinkAboutWacker OFFICE OF THE TOWN CLERK • 0,'
Town of Southold 41
Judith T. Terry, Town Clerk %
Town Hall, 53095 Main Road
P. O. Box 1179 h � •
Southold, New York 11971 O� •�
Telephone _"'�( *5
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 144 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool X
NAME OF OWNER: Robert Wacker
OWNER MAILING ADDRESS: , 2455 Nassau Point Road
Cutchoque, New York 11935
OWNER PROPERTY ADDRESS: 2455 Nassau Point Road
Cutchoque, New York 11935
OWNER TELEPHONE NUMBER: 516-734-6882
TAX MAP NO. : Section 104 Block 13 Lot 6
CROSS STREET: Broadwaters Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: 1984
Judith T. Terry /'
Southold Town Clerk
DATE: November 13, 1986
(TOWN SEAL)
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45.
OFFICE OF THE TOWN CLERK
Town of Southold �� , ._ COl' Application No. NV
Judith T. Terry, Town Clerk .y i
G ) Residential
Town Hall, 53095 Main Road -
cr� k, iw ` Non-Residential
0
P. O. Box 1179 � ,.
Southold, New York 11971 O '®j4 -s e�
Telephonet.4
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. MY
Fee $ f(9• Q'o
DATE /4011e 9 C
OWNER NAME: e >e r t 11q4e kc. v
OWNER MAILING ADDRESS: 4t{s"-''" l fc.s.t
OWNER PROPERTY ADDRESS: e , ,
OWNER TELEPHONE NUMBER: 7 z 2
TAX MAP NO. : Section /, ,e Block / 3 Lot
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential .- Non-Residential
DATE OF PREVIOUS PUMP-OUT: f, sG
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.)
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T>C3U.tZLe LL.)
l' Signature of Applicant
RECEIVED B Y: Cj[-71._c2 c-__
RENtwn erk's office
DATE: 'MOk! 13 1CM
Tom Citft Southold
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