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HomeMy WebLinkAboutWalz vsefuilf ,4` ofk, A��lel` .� ®�� �z ,'rri Town Hall, 53095 Main Road �f o, 1� P.O. Box 1179 Southold, New York 11971 00' JUDITH T.TERRY -< .r r� �� FAX(516)765-1823 TOWN CLERK TELEPHONE(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. 1474-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner WALZ, DONALD P. Mailing Address 1 3302 CORINNA DRIVE Mailing Address 2 City St Zip RANCHO PALOS VERDES CA 90274-0000 Property Address 1 74 NORTH ROAD Property Address 2 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 213-377-0256 Tax Map No. section 44.00 block 1 lot 3.000 Cross Street ALBERTSON'S LANE Date Of Last Pump Out 0/00/00 eigiedieolo • Issue Date: 6/01/90 Judith T. Terry Southold Town Clerk (TOWN SEAL) • „ • OFFICE OF THE TOWN CLERK ' - 'cwFFD(,(� -- Town of Southold � .;_ CO •• Application No. /417(/ Judith T. Terry, Town Clerk `Grp y ��< �G Town Hall, 53095 Main Road � •�-� �=�z� . $10.00 - Residential P. o O. Box 1179t �,.�,;::.•,t ;.:,•.�:L;;�• h�i � $25.00 - Non-Residential • ' Southold, New York 11971 • 0�,���` Telephone �� (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ DATE L 9/ `M" OWNER NAME: a A./au i? �AL ^- • OWNER MAILING ADDRESS: 3 /4,45 vie/mss CA, 9'0274 OWNER PROPERTY ADDRESS: -741 fJ ,.' cD€44d/ t" 7l OWNER TELEPHONE NUMBER: (2., ) ) 77_ O.2 57‘. TAX MAP NO. : Section Iftii• Block Lot CROSS STREET: l‘ ,r1-$o,R•/' S c-rv�_. TYPE OF SYSTEM: Septic Tank New Existing Cesspool ` New Existing Residential Non-Residential DATE OF PREVIOUS PUMP-OUT: L►r✓.4wa e✓A/ ---/vat ,S iaa Ce• /q79 G 444.S-/— LOCATION 44.S-/—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.) igna ure of Ap scant RECEIVED BY: % ,.. Town C rk's Off ce DATE: 9/A/i, I ) 9 90 • • - _ 1, 4 _, . ' i. — _ f t — ;�,` • _ s • `J•. .. ' e - - 5.41,• ''`-___ • - -,tt _ ,' ' _ - ., 4 J - ` I , • , ,, • • • rtC : _. •1 , _5 . , ., : , .... _ . . ...... ,_ , . . . . , • . ,,-., ,,,c-c44„, . ,. . . , . . .. ..... . . . . . . . .. ., . , . _ . .. .... ... ., , .. .. . •. . _. , , , . . ., . ,„ • . . , . , .. , .. ,... , , ...., ..._ • _ .. , .. , _, . ,... . . ,....., .. . . , . .. , „ , • .. , .. . .. . . _ . ,„. „ . . ,, , , .... ,_ .. „ . .:. , .,„, ._, , r, , . • • .. ., , , , ..,., , .,„ , , ....., . _. • . . . . , ,. , . _ , . . .. . . ,.... , • ,, , .• . . . . . . , . . . . . -. , , • „ . .., . . .• . _ . . . . . .„,.. .., • , . , , . . . , ,.... .. .. , . .... . , , ,.. , ..„, ,,,, . .,. ,',. • , _, ,.:,, , ••, , ...I H. _ k. .,.., , . . , h . . ( -e--- , ' :,,. / , , , , ,_. ,.,....• , , , , , . ' _ (Of , g 'A- ' • . ,nr - ,• ` ',L = - •t' Y•.. ' • J 1 ' r