HomeMy WebLinkAboutBredemeyer 0,0,0004 ,
Town Hall, 53095 Main Road
eZr � P.O. Box 1179
l o." Southold, New York 11971
JUDITH T.TERRY ����ri� �� 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. 1220-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner BREDEMEYER, JOHN M., Ill
Mailing Address 1 P. O. BOX 245
Mailing Address 2
City St Zip ORI ENT NY 11957-0000
Property Address 1 425 OLD FARM ROAD
Property Address 2
City St Zip ORIENT NY 11957-0000
Owner Telephone No. 516-323-2708
Tax Map No. section 25.00 block 5 lot 7.000
Cross Street ORCHARD STREET
Date Of Last Pump Out 0/00/00
Issue Date: 8/25/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK oS\FFo�`�t
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Town of Southold Off, , �'� = Application No.
Judith T. Terry, Town Clerk "f #= `
Town Hall, 53095 Main Road w ; ,r4 $10.00 - Residential
P. O. Box 1179 cry °' •
:�• • 3#;:�;� �• $25.00 - Non-Residential
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Southold, New York 11971
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Telephone `,( , �����•
(516) 765-1801 •
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE ��� �S /987 7
OWNER NAME: `'` /1 /%/. 5/edeJ1eye
OWNER MAILING ADDRESS: ROSV -2
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OWNER PROPERTY ADDRESS: Z.02,5-. old tqA9/7) ,Qe1)
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OWNER TELEPHONE NUMBER: •5/6- 302- 3 -.Z 7Os
TAX MAP NO. : Section c7,2_3" Block 5 Lot 7
CROSS STREET: O G1 12z S7 ' T
TYPE OF SYSTEM: Septic Tank X(') New - Existing 01<"
Cesspool >(..C. ) New Existing -)11<
Residential 5x` Non-Residential
DATE OF PREVIOUS PUMP-OUT: //O�E •-vIOip / 0 8 A/ause®1/ 805�
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.)
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dir Signature of Applicant
lRECEIVED BY: /AV - ,(//
alirthal
Town Cleerk's Office
DATE: /5, l 9
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