HomeMy WebLinkAboutBrandes r°. ,
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Town Hall, 53095 Main Road
O - . �` P.O. Box 1179
� �+�• Southold, New York 11971
JUDITH T.TERRY _ ,,��'� 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. 1090-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner BRANDES, LEE G.
Mailing Address 1 P. O. BOX 88
Mailing Address 2
City St Zip NEW SUFFOLK NY 11956-0000
Property Address 1 MAIN STREET
Property Address 2
City St Zip NEW SUFFOLK NY 11956-0000
Owner Telephone No. 516-854-0458
Tax Map No. section 117.00 block 8 lot 2.000
Cross Street FOURTH STREET
Date Of Last Pump Out 0/00/85
Issue Date: 4/26/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERKc\WFU/A- '-
Town of Southold Q L� = Application No
Judith T. Terry, Town Clerk - y .
Town Hall, 53095 Main Road o ‘!'.;;A Residential
P. O. Box 1179 cn T: *. '�`"%? •
�.•��: >��• �i Non-Residential
Southold, New York 11971 O ®. O�'•��
Telephone- - . _ _ *oj" yi-
(516) • 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE _3141\$q
OWNER NAME: \..,e C. cNcae�
OWNER MAILING ADDRESS: p .K
OWNER PROPERTY ADDRESS: 1.-‘41'.-
OWNER TELEPHONE NUMBER: (.-(fir) Jn{_�j,.�
TAX MAP NO. : Section l I`T Block 9 Lot
CROSS STREET: frovgr Cc1-
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool v New Existing 7'
Residential V 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.)
Ap
Signature of Applicant
RECEIVED BY:
itEcbtr� n lerk's ffice
DATE: APR 2a19B
Grandes House , 4th . & Main Sts .
New Suffolk , NY 11856
Cesspool
a
i
— 75 '
House
Fourth Street