HomeMy WebLinkAboutWelcker •
OFFICE OF THE TOWN CLERK • FQ o
Town of Southold �� (0
Judith T. Terry, Town Clerk A ��
Town Hall, 53095 Main Road
P. 0. Box 1179 iA U' �t r
Southold, New York 11971 .®
Telephone =701 y ‘W
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 446 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: Robert Welcker
OWNER MAILING ADDRESS: SO East Legion Avenue
Mattituck, New York 11952
OWNER PROPERTY ADDRESS: 80 East Legion Avenue
Mattituck, New York 11952
OWNER TELEPHONE NUMBER-: 516-298-8562
TAX MAP NO. : Section 143 Block 4 Lot 13
CROSS STREET: North Riley Avenue
TYPE OF SYSTEM: Septic Tank New Existing
•
Cesspool X New Existing Xi
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: May 17, 1987
Judith T. 'Terry
Southold Town Clerk
DATE: September 28, 1987
(TOWN SEAL)
OFFICE OF THE TOWN CLERK cOFO(r�
Town of Southold Application No.41
Judith T. Terry, Town Clerk �`1 Residential
Town' Hall, 53095 Main Road o r -
P. O. Box 1179 • Non-Residential
Southold, New York 11971 ® em
Telephone _ i ,;
(516) 765-1801
TOWN OF SOUTHOLD
RECEIVED SOUTHOLD WASTEWATER DISPOSAL DISTRICT
AUG 1987 APPLICATION
Town Clerk Southold
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /0
DATE
OWNER NAME: -
-�-
OWNER MAILING ADDRESS: tO
a
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: - J P— `—
TAX MAP NO. : Section / Block IS\ Lot / Z
CROSS STREET:
TYPE OF SYSTEM: Septic ,ank New Existing
Cesspool New Existing
Residential i— Non-Residential
7\DATE OF PREVIOUS PUMP-OUT: !�'7 *A"%/ /17
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.)
/.4e1/ 1Signature Applicant
RECEIVED BY:4L�
Town Jerk's Office
CIKE1VE®
DATE:
SEP 28 `T •7
Too Ctsrk Southold
t.,
C
.--.•
,.. --.4eilla,- ..• t
' 11104/11L' i''
VI
E •
i
1. ..--...<--
i