HomeMy WebLinkAboutAnderer OFFICE OF THE TOWN CLERK i �FF'U
Town of Southold , OQ� `Cy
Judith T. Terry, Town Clerk Z •
Town Hall, 53095 Main Road
P. O. Box 1179 ;.
Southold, New York 11971 �l �O�-
Telephone 0l a I
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
•
Operation Permit No. 112 Residential X
Fee $ 10.00 Non-Residential
Septic X Cesspool X
NAME OF OWNER: Henry and Kathleen Anderer
OWNER MAILING ADDRESS: Hickory Road
Southold, New York 11971
OWNER PROPERTY ADDRESS: Hickory Road
Southold, New YOrk
OWNER TELEPHONE NUMBER: 516-765.3322 ._
TAX MAP NO. : Section 54 Block 9 Lot 1
CROSS STREET: Soundview Avenue
TYPE OF SYSTEM: Septic Tank New existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: September 1986
Judith T. Terry
Southold Town Clerk
DATE: October 28, 1986
(TOWN SEAL)
i _
OFFICE OF'=1 HE TOWN CLERK � Fp
Town of Southold �� t
-*%,447--tir Application No.//c,2_.
Judith T. Terry, Town Clerk Residential
Town Hall, 53095 Main Road a te., -
P. O. Box 1179 E OAS a ` Non-Residential
Southold, New York 11971 D ®{ f
Telephone o,( '1%%S./
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OCT 1986
"own
OAgputhold, APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. //c
Fee $ /6
DATE ' 77, 6' z£s-
OWNER NAME: /f6/n/16r d // • ew
OWNER MAILING ADDRESS: /-//e/Go2Y r2 _,9-'
Soc)TF./oG , /A / ' //ci 7/
OWNER PROPERTY ADDRESS: &,v ��ic�Go2rV 20,4-I2 co�.uc�iz-
Sou uvviEw 19ver
OWNER TELEPHONE NUMBER: 33 Z2
TAX MAP NO. : Section S67/ Block 4F Lot
CROSS STREET: .10.,( e 677,�_
TYPE OF SYSTEM: Septic Tank New Existing X
Cesspool ?G 1�/ New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: 471 efr6
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: G2 fir_ �a� �
Townrk's Office
DATE: / 6 - 02
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