HomeMy WebLinkAboutZimmer �p,�/LCL%:�.+�-.
Ch1'
A Town Hall, 53095 Main Road -
W P.O. Box 1179 19/
® $ Southold, New York 11971
JUDITH T.TERRY FAX(516)765-1823
TELEPHONE(516)765-1801
TOWN CLERK
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. 1744-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner ZIMMER, JOE
Mailing Address 1 2045 LAKE DRIVE
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 2045 LAKE DRIVE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-1454
Tax Map No. section 59.00 block 5 lot 4.000
Cross Street LAKE COURT
Date Of Last Pump Out 0/00/00
Issue Date: 9/04/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
O1F'ICE •
OF THE TOWN CLERK •cOFIZA/'•
Town of Southold CG cation No.
Off, D ' pplijV5,6
Judith T. Terry, Town Clerk
y $10.00 - Residential
Town Hall, 53095 Main Road . 4..
' P. O. Box 1179
f,:is�'-3 $25.00 - Non-Residential
Southold, New York 11971 O ��
`u �� ���
Telephone 0.(= % ,
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE
OWNER NAME: ,7-04-
OWNER MAILING ADDRESS: 240, ,C` ,� .'�. G-' . - 4
..$;aG rwaz-z, • //f 7/
OWNER PROPERTY ADDRESS: 4.9�4A9A-
OWNER TELEPHONE NUMBER: 76.E_/p5
TAX MAP NO. : Section "6- 7 Block Lot JLC
CROSS STREET: 4.44fCele
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool // New Existing l/
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: �'/g-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.)
v✓
ig re of Applicant
RECEIVED BY:
Town lerk's Office
DATE:
SEP 0419°1
Ion GO bol
•
.. -----------_-._..-_._._., -_ -.
•
•
_ „� //�.�. ,,rrte� - _ _- , - Y
/
•
•( •f I '_ (/q.�� , 1 - .f.�� L tib' _ -
+ , f '' • +'1 - ' ' . ' ' - 17-7-"'- --,--'''''',-"--
1,nr�^,.,. -`,.�' <. .,�^..--''tom_.:��,. ..,,^ ,•�F r S ^ l,