HomeMy WebLinkAboutWolbert OFFICE OF THE TOWN CLERK ' IS�FFD(K„'
Town of SoutholdI-
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Judith T. Terry, Town Clerk �`, .:
Town Hall, 53095 Main Road
P. O. Box 1179
Southold, New .York 11971 •
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Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 63 Residential XX
Non-Residential
Fee $ 10.00
Septic Cesspool XX
NAME OF OWNER: James and Linda Wolbert
OWNER MAILING ADDRESS: P.O. Box 558
Mattituck. New York 11952
OWNER PROPERTY ADDRESS: 1=480 West Mill Road
Mattituck, New York 11952
OWNER TELEPHONE NUMBER: 516-298-5942
TAX MAP NO. : Section 106 Block 10 Lot 2.2
CROSS STREET: Bayview Avenue
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool XX New Existing x
Residential XX Non-Residential
DATE OF PREVIOUS PUMP-OUT: NONE
Judith T. Terry
Southold Town Clerk
DATE: September 23, 1986
(TOWN SEAL)
OFFICE OF THE TOWN CLERK Ic,\\FFOur
Town of Southold BOG'; Application No.�o 3
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Judith T. Terry, Town Clerk �j �'�
Town Hall, 53095 Main Road o I x Residential
P. O. Box 1179 cn ,, ' '►'��: Non-Residential
" •
Southold, New York 11971 O r r
•
Telephone _ 1 [ ,
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERAT ION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 71, 3
Fee $ 22
DATE /6C:;
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OWNER NAME: 0-'4t ((t., - b--) C9C-if3)07 �
OWNER MAILING ADDRESS: r
Afy 1/
OWNER PROPERTY ADDRESS: ("- We5rB74G�
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OWNER TELEPHONE NUMBER: J(o — (9-98 -S`9CIP
TAX MAP NO. : Section /® 6 Block Z00 Lot 2"
CROSS STREET: c442,94//ga) Aeet..z/67- siboarke- ea-P. /),2d7964-07'
TYPE OF SYSTEM: Septic Tan New Existing
'"Cesspool New Existin
Residential ) Non-Residential �,
DATE OF PREVIOUS PUMP-OUT: /gyp' � � ea.
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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.)
/(1/1/ /Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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