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SOFFICE OF THE TOWN CLERK FOC,kc
Town of Southold �� ; � r �G
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Judith T. Terry, Town Clerk `Z D E �'''�' �
Town Hall, 53095 Main Road I a ',.
P. 0. Box 1179 \u' a:µr VA7,
Southold, w
New York 11971 O� Otr
Telephone 1 a ,
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
CONSTRUCT ION OR ALTERAT ION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 104 Residential X
Non-Residential
Fee $ 10.00
Septic X Cesspool X
PERMIT ISSUED TO:
NAME: Robert Johnsen
ADDRESS: 4300 Soundview Avenue
Southold, New York 11971
DESCRIPTION OF PROPOSED CONSTRUCTION or ALTERATION
New system
LOCATION OF PROPOSED CONSTRUCTION or ALTERATION:
OWNER OF PROPERTY: Gretchen Hiegl
OWNER MAILING ADDRESS: P.O. Box 22
Peconid, New York 11958
OWNER PROPERTY ADDRESS: Soundview Avenue
Southold, New York
•
TAX MAP NO. : Section 68 Block 1 Lot P/0 14
CROSS STREET: .8 mile east of Mill Lane
BUILDING PERMIT NUMBER CROSS REFERENCE: Unknown
Judith T. Terry
Southold Town Clerk
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DATE : February 9, 1987
, (TOWN SEAL)
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•4 P.O. Box 1 179
, 06. Southold, New York 11971
JUUITII T TERRY ���i�i�wol TELEPHONE
TowN CLI ILI: (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
February 9, 1987
Robert Johnsen
4300 Soundview Avenue
Southold, New York 11971
•
Re: Gretchen Heigl
Soundview Avenue,
Southold,
venue-
Southold, New Y& rk
Enclosed herewith is the Construction, Alteration or Modification
Permit for a Septic'Tank or Cesspool System for which you applied.
Please be advised that each owner of real property operating an
on-site sewage disposal system, such as a septic tank or cesspool must,
prior to such operation, possess in the name of the owner an Operation
Permit for the system. The Operation Permit is issued by the Town
Clerk's Office.
The fee for an Operation Permit is ten dollars ($10. 00) for
residential use and twenty-five dollars ($25. 00) for non-residential.
Please have the owner complete the enclosed Application for an Operation
Permit and return it to this office along with the proper fee.
•
For your general information I have enclosed an Informational
Bulletin regarding the Scavenger Waste Laws adopted by the Southold
Town Board. Should you have any questions pertaining to either permits
or the Scavenger Waste Laws, please do not hesitate to contact this
office. We will be glad to assist you in any way possible.
Very truly ?fours,
Judith T. Terry
Southold Town Clerk
Enclosures (3)
JTT/Ijc
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OFFICE OF THE TOWN CLERK •
Town of Southold Application No. A
Judith. T. Terry, Town Clerk
Town Hall, 53095 Main Road Construction
P. 0. Box 1179 Alteration
Southold, New York 11971
Telephone •
Residential
(516) 765-1801 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. /061 •
Fee .$ /d w--
DATE / — c� -- S3"c
APPLICANT NAME: R o6e, f S-€a d
APPLICANT ADDRESS: 4-7) S c (4.v dd
S�e�TLi��cJ
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
Aif / a�
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY : C'Re T�� .e n
OWNER MAILING ADDRESS: o a V
OWNER PROPERTY ADDRESS: Soc>vt.cl u.env Ac's okei
TELEPHONE NUMBER OF CONTACT PERSON: 7c s--j/L• s-
TAX MAP NO. : Section S> Block / Lot PO dig
CROSS STREET: e4 vq. J 4
BUILDING PERMIT NUMBER CROSS REFERS
V Signa lire of Applicant
RECEIVED BY: e„,,,
Town lerk's/Office
DATE: � /ice
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LICENSED LAND SU VEYORS 17 t _ 4'4'0 LAND
GREENPORT NEW YORK
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