HomeMy WebLinkAboutWaitz OFFICE OF THE TOWN CLERK •cvFFUC re-
Town of Southold �O
Judith T. Terry, Town Clerk J'
Town Hall, 53095 Main Road ^.
P. 0. Box 1179V y� •
Southold, New York 11971 p 4
Telephone _dol Mg
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 257 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool X
•
NAME OF OWNER: Lawrence T. Waitz
OWNER MAILING ADDRESS: RR 1 , 4595 Skunk Lane
Cutchoque, New York 11935 •
OWNER PROPERTY ADDRESS: 4595 Skunk Lane
Cutchogue, New York
OWNER TELEPHONE NUMBER: 516-734-5871
TAX MAP NO.: Section 103 Block 6 Lot 3
CROSS STREET: Pine Tree Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: December 12, 1986
Judith T. Terre
Southold Town Clerk -
DATE: April 2, 1987
`,(TOWN SEAL)
III 41.
OFFICE OF THE TOWN CLERK ���FFD •
Town of Southold c0 ' Application No. as
Judith T. Terry, Town Clerk . g(4;;CW4%kl'I
Town Hall, 53095 Main Road Residential
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P. 0. Box 1179 u' ���
; : _ ;' Non-Residential
Southold, New York 11971
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERAT ION PERMIT
SEPTIC TANK or CESSPOOL
•
Operation Permit No.
Fee $ /0
DATE j b A)
OWNER NAME: L v° I�Q� e� /i/L42_
OWNER MAILING ADDRESS: tu, Lyic-97) % __._4/Y
re.6) /47 1/
OWNER PROPERTY ADDRESS: ‘5.4-M
OWNER TELEPHONE NUMBER: 73 SY?
ti TAX MAP NO. : Section /0 3 Block Lot 3
CROSS STREET: `yj.Au_ ��} ,ems,
TYPE OF SYSTEM: Septic Tank New Existing 1\
Cesspool K New Existing X'
Residential Non-Residential �°
DATE OF PREVIOUS PUMP-OUT: Q ' (� / 7 ?0
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.)
I/0 ri e7
Signature of Applicant
RECEIVED BY: c&,au
Town Cjerk's 0 fice
RECEIVE*
DATE:
P.NK 0-2 7987
Town Clerk Southold
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