HomeMy WebLinkAboutAndreef OFFICE OF THE TOWN CLERK cOQ[,� -.�
Town of Southold � aj ,
Judith T. Terry, Town Clerk
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Town Hall, 53095 Main Road o I� A
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P. 0. Box 1179 ' �` lago:
Southold, New York 11971 \ ••
Telephone ®�H; [ �� •
(516) 765-1801 -
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation. Permit No. 590 Residential X
Non-Residential
Fee $ 10.00 Septic Cesspool X
NAME OF OWNER: Michael Andreef
OWNER MAILING ADDRESS: 315 East 69th Street, Apt. 10J
New York, New York 10021
OWNER PROPERTY ADDRESS: 326 Knapp Place
Greenport, New York 11944
OWNER TELEPHONE NUMBER: 212-794-8151 (Day time)--
TAX MAP NO. : Section 34 Block 2 Lot 18.1
CROSS STREET: Main Street
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: 1987
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Judith T. Ter
Southold Town Clerk
DATE: January 99, 1988
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'(TOWN`SEAL)
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OFFICE OF THE TOWN CLERK
Town of Southold ® o C•
�, Qom'' Application No.
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road ` Residential
P. O. Box 1179 C°' • ,.,moi , Non-Residential
Southold, New York 11971 *CeS—
Telephone 70 0
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ (O. Oo
DATE I /2 J d-t
OWNER NAME: 14(: (-31e(- (- Aio( e / P
OWNER MAILING ADDRESS: 3 (s"' 'Cd I I ‘14. Al pi (o
/( t w I b 021
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OWNER PROPERTY ADDRESS: 2C k a jq ° (0
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OWNER TELEPHONE NUMBER: (2'(2 ) ?VI— ?(S'f (dcy0'1
TAX MAP NO. : Section V Block Lot ,i ,/
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing X
Residential Non-Residential
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DATE OF PREVIOUS PUMP-OUT: I "I 17
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 Ap cant
RECEIVED BY: .
TownaClerk's ffice
DATE:
RECEIVED
JAN291997
.Town Clerk Southold
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