HomeMy WebLinkAboutZimmer OFFICE OF THE TOWN CLERK $ 'OFOUre •
Town of Southold ,
Judith T. Terry, Town Clerk Z rr
Town Hall, 53095 Main Road c
P. O. Box 1179 ' s' •
Southold, New York 11971 ` Q y- O�-
Telephone ^ 4,
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 197 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool X
NAME OF OWNER: Angie Zimmer
OWNER MAILING ADDRESS: 48 Glen Brook Crest Drive
Short Hills, New Jersey 07078
OWNER PROPERTY ADDRESS: 165 Rogers Road, Beixedon Estates
Southold, New York
OWNER TELEPHONE NUMBER: 201-376-6429
TAX MAP NO. : Section Block r OZ Lot 07�
CROSS STREET: Orchard Road and Rogers Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: October 1986
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Judith T. Ter
Southold Town Clerk
DATE: January 9, 1987
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\ (TOWN' SEAL)
OFFICE OF THE TOWN CLERK c.OFO(,r
Town of Southold t� CQG' Application No./.97
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road ` Residential
P. O. Box 1179 =X • •' -Non-Residential
Southold, New York 11971ho�.
Telephone = .! 0"..�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
--for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. / 7
Fee $ /0
DATE / I 369"b�
OWNER NAME: A A/6 I @/"l/27 Efl
OWNER MAILING ADDRESS: q-erGLFA/ 1313v K C ✓lfr 51 DR
- Alit .5 4/./ 07o7. !
OWNER PROPERTY ADDRESS: / f2 fla6=66 5 /� D
f ,/ 54-J5 (.1-fdc L j) V
OWNER TELEPHONE NUMBER: 2, 0 / 374 6 ?. 9
TAX MAP NO. : Section / 3 3 Block Lot / 2—
CROSS
-CROSS STREET: V/,1 cigila J) fl/) -- Ra r---135
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TYPE OF SYSTEM: Septic Tank New Existing
Cesspool � New Existing i,/`
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: /a
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 roads)
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m. Applicant
RECEIVED BY: c x_et
R QOIWown C rk's Of ice
DATE: JAN 0 9 1q81
Town Clerk Southold
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