HomeMy WebLinkAboutCierach OFFICE OF THE TOWN CLERK $ icOFQ it
Town of Southold
Judith T. Terry, Town Clerk II � '
Town Hall, 53095 Main Road Of' �' Y'
P. 0. Box 1179 !Acn 'aa `
Southold, New York 11971 p -4- ..z:°'•
Telephone �'OI l b
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 502 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: Stanley A. Cierach, Jr and Linda Cierach
OWNER MAILING ADDRESS: 1765 Main Bayview Road
Southold, New York 11971
OWNER PROPERTY ADDRESS: 1765 Main Bayview Road
Southold, New York
OWNER TELEPHONE NUMBER: 516-765-2373
TAX MAP NO. : Section 70 - Block 8 Lot 53
CROSS STREET: Clearview Avenue
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: March 15, 1986
Judith T. erry
Southold Town Clerk
DATE: December 1, 1987
(TOWN SEAL)
OFFICE OF THE TOWN CLERK l COMA'��'-
Town of Southold DSO CQ ' , Application Nc j'®c
Judith T. Terry, Town Clerk ~"
Town Hall, 53095 Main Road o :c Residential
P. 0. Box 1179 .w � Non-Residential
Southold, New York 11971
Telephone /
•
(516) . 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
- for - .
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.c Og-
Fee $ 10'®0 0
DATE @ 1 )/7/ q7
(' I
OWNER NAME: stal)C Gl T/J�� ��i �ly1Q�+ eeerroC
OWNER MAILING ADDRESS: 11 (PC H Ai10 AaA I4°,{,d
r).,it(rtp l ,
OWNER PROPERTY ADDRESS: ,fin y��_
OWNER TELEPHONE NUMBER: 5-((m/7(os� /313
�3
TAX MAP NO. : Section 0j , 0 Block ef / 7 Lot n 9 ��
CROSS STREET: C.rXavvL AJ Ce.
TYPE OF SYSTEM: Septic Tank New Existing /
Cesspool / New Existing I/
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: 3 -I S' g(p
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.)
Signature of Applicant
RECEIVED BY: -0114 •�,� /
n C`T k's 0 fice
DATE: �� � �
t
? O
irl°7f V
Pi
f!
i
rJ1
ilu�� P),4d el.o `'r l�
, c��f
)ti