HomeMy WebLinkAboutBischoff opt
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Town Hall, 53095 Main Road
�r P.O. Box 1179
ialan �0 Southold, New York 11971
JUDITH T.TERRY FAX FAX(516)765-1823
TOWN CLERK TELEPHONE(516)765-1801
REGISTRAR OF VITAL STATISTICS
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1222-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner BISCHOFF, GEORGE •
Mailing Address 1 P. O. BOX 902
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 445 VANSTON ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-6717
Tax Map No. section 104.00 block 12 lot 15.000
Cross Street NASSAU POINT ROAD
Date Of Last Pump Out 0/00/69
•
Issue Date: 8/25/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK 'g��F��,
Town of Southold C� Application No. i/ e c
Judith T. Terry, Town Clerk °'` '
Town Hall, 53095 Main Road08-7. �rx� -t
$10.00 - Residential
P. 0. Box 1179 td7 Win.*>: �-�L
��'. *3Y'�a „ �
,�; �� � $25.00 - Non-Residential
Southold, New York 11971 �0 ��`
Telephone _ ,( ., ,.
•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE 7/3 /A,- 9-
'OWNER
NAME: OfO//f Ccs • / C //0
OWNER MAILING ADDRESS: 'PO 0.X 9Q ,
6U7 /o‘�r //9a5
OWNER PROPERTY ADDRESS: -. 5 k2LJ7 ./Z) c '
(/ 0. C606,4 I/ �/
OWNER TELEPHONE NUMBER: 78 _ (0 7/ 7
TAX MAP NO. : Section // Block )'Z_ Lot '1�".;
CROSS STREET: �% CSA-Q_��c� i
C \.
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool f/ New Existing
Residential 1/ 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.)
i riat re of Applicdn, /
RECEIVED BY: 137, ,
Town Clerk's I • -e
DATE:
. 6-tVf�s ,,/J
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