HomeMy WebLinkAboutWeidmann OFFICE OF THE TOWN CLERK
F
' Town of Southold
Judith T. Terry, Town Clerk /,
ti
,Town Hall, 53095 Main Road 1911
P. O. Box 1179
Southold, New York 11971 Q Q�- •�
Telephone Q( 4a 't
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION' PERMIT
SEPTIC TANK or CESSPOOL,
Operation Permit No. 405 Residential X
- Non-Residential
Fee $ 10.00 -
Septic Cesspool X
- NAME OF OWNER: Gustave and Margaret Weidmann
OWNER MAILING ADDRESS: P.O. Box 221
Peconic, New York 11958
OWNER PROPERTY ADDRESS: 3245 Wells Road
Peconic, New York
OWNER TELEPHONE NUMBER: 516-765-5671
TAX MAP NO. : Section 86 Block 2 Lot 7
CROSS STREET: Main Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New ExistingX
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown •
Judith T. Ter
Southold Town Clerk
DATE: August 19, 1987
' f
(TOWN SEAL)
OFFICE OF THE TOWN CLERK c3IFeu(
Town of Southold �� CQG'; Application No. 41a-5—
Judith T. Terry, Town Clerk
� � 7.4 Residential
Town Hall, 53095 Main Road `
P. O. Box 1179 Non-Residential
Southold, New York 11971 O • _ ��
Telephoneti
(516) 765-1801 •
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT •
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 171d
Fee $
DATE
OWNER NAME: 4, �� �-% �S . ( � ,� ee i1,1 ..f{Yy 1,
OWNER MAILING ADDRESS: 3 I 6_57cit pc Eux. oZ '- I
r\ y
OWNER PROPERTY ADDRESS:-
OWNER TELEPHONE NUMBER: s- 1
TAX MAP NO. : Section 6, Block �/ Lot
CROSS STREET: `-f-Y7 /J /
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool t/ New Existing V1r,
Residential L7 Non-Residential
-- DATE-OF PREVIOUS PUMP-OUT:
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.)
,UL
Signatu ,e of Applicant
RECEIVED BY:547L.EE"c..-
REC lVDDTown Jerk's 0 ce
DATE: AUG 1 9 1987
Town Clerk Southold
a )
Hie I Oh