HomeMy WebLinkAboutWalser ,'IIS 1F-01 3.4,
$0,43# ' t‘.
Town Hall, 53095 Main Road
cf., /i$ P.O. Box 1179
— I j ( net. Southold, New York 11971
JUDITH T.TERRY -® i,$� TELEPHONE
TOWN CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 744-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner WALSER, LAWRENCE
Mailing Address 1 1475 KENNY'S ROAD
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 1475 KENNY' S ROAD
Property Address 2
City St Zip SOUTHOLD 00000-0000
Owner Telephone No. 516-765-3804
Tax Map No. section 59.00 block 7 lot 17.001
Cross Street SOUNDVIEW AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 6/27/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK ,/
Town of Southold ��v CQ ' , Application No.7 C
Judith T. Terry, Town Clerk y
Town Hall, 53095 Main Road o <; -.4 Residential
s µ�
P. O. Box 1179cn ; 1 Non-Residential
Southold, New York 11971 OO
Telephone � e0
(516) 765-1801
1
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
- v 4
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
,/ i 4
Operation Permit No. 7�"
Fee $ to
DATE Z ?.3/1V---6.
OWNER NAME: oZaC t9eE'f/�f/lit/ ,
OWNER MAILING ADDRESS: 1(17,r ,-ert/ ,
> 1# / /197/
OWNER PROPERTY ADDRESS: 4~
OWNER TELEPHONE NUMBER: 21Q'C'3P19SG
' TAX MAP NO. : Section Block, 7 Lot /7./
CROSS STREET: .gv cfV:•PGJ tele. C`$
TYPE OF SYSTEM: Septic .Tank New Existing /
Cesspool - New Existing ✓
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: Z-Wee3
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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Sigrofplicant
RECEIVED BY: '43
RErniown ,%lerk's S fice '
DATE: ,MN 2 7 19 8
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