HomeMy WebLinkAboutBakelaar OFFICE OF THE TOWN CLERKs •CJ�FFe[/r`+'
Town of Southold a
Judith T. Terry, Town Clerk G`,
Town Hall, 53095 Main Road r'
P. O. Box 1179 Icn Tit sr,
Southold, New York 11971 p
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Telephone = j
(516) 765-1801 ar •
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 251 Residential X
Fee $ 10.00 Non-Residential
} Septic Cesspool x
NAME OF OWNER: Philip Bakelaar
OWNER MAILING ADDRESS: 45 Booth Place -
Greenport. New York 11944 •
OWNER PROPERTY ADDRESS: 45 Booth Place
Greenport, New York 11944
OWNER TELEPHONE NUMBER: 516-477-1824
TAX MAP NO. : Section 41 Block 1 Lot 21
CROSS STREET: Wilmarth Avenue
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Approx. 15 years ago. 19727
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Southold Town l -
DATE: March-31 , 1987
I (TOWN SEAL)
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OFFICE OF THE TOWN CLERK c0FO(A-
Town of Southold Application No. a6
Judith T. Terry, Town Clerk . Af'
53095 Main Road t- -� i Residential
Town Hall, a �
P. O. Box 1179 u-3 " e- z Non-Residential
Southold, New York 11971 0 T%.tV.0 •�`
Telephone _0?t •
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION ,PERMIT-
SEPTIC TANK or CESSPOOL
Operation Permit Noc�1
Fee $ /Qecro
DATE
OWNER NAME: ,
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OWNER MAILIN3 ADDRESS: p ,z
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OWNER PROPERTY ADDRESS:
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OWNER TELEPHONE NUMBER: 4-'7' _ / g U •
TAX MAP NO. : Section_g / Block / Lot oQ
CROSS STREET: j,_c_Q�yy x � '
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential < Non-Residential
DATE' OF PREVIOUS PUMP-OUT:
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.)
,/nature of Applicant
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RECEIVED B Eer,
own lerk's fice
DATE:
MBAR 3 O 1987
Town C4fIrk Southold
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