Loading...
HomeMy WebLinkAboutDavison OFFICE OF THE TOWN CLERK � OU( Town of Southoldlj Judith T. Terry, Town Clerk Town Hall 53095 Main Road ''` `` • P. O. Box 1179 '`Ln Southold, New York 11971 p" yob Telephone o� (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation. Permit No. 529 Residential X Non-Residential Fee $ 10.00 Septic Cesspool X NAME OF OWNER: Eugene Davison OWNER MAILING ADDRESS: 4300 Sound Avenue Mattituck, New York 11952 OWNER PROPERTY ADDRESS: 4300 Sound Avenue Mattituck, New York OWNER TELEPHONE NUMBER: 298-4644 TAX MAP NO. : Section 121 Block 3 Lot 5 CROSS STREET: Bergen Avenue TYPE OF SYSTEM: Septic Tank New Existing Cesspool X ,New X (Stable)Existing Residential X Non-Residential DATE OF PREVIOUS PUMP-OUT: NA t'h . Southold Town Jerk DATE: December 11 , 1987 (TOWN SEAL) OFFICE OF THE TOWN CLERK SIFD(,r� Town of Southold . C • Application No. � pp JL y oma, Judith T. Terry, Town Clerk IPA -- Town Hall, 53095 Main Road :'� Residential P. O. Box 1179 u' s • Non-Residential Southold, New York 11971 � , `O� ���`� .o Telephone ,( `)► '� • (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ /o. DATE fa1 ( /V? OWNER NAME: (-2G C.)-LJ OWNER MAILING ADDRESS: 3 Sova A.,( C t196- Z_ 10 77 OWNER PROPERTY ADDRESS: S62-/1.i/�= OWNER TELEPHONE NUMBER: TAX MAP NO. : Section fZ. f Block Lot CROSS STREET: gG 6'y /4 (4-- TYPE OF SYSTEM: Septic Tank New )( Existing Cesspool New y Existing 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.) . , w_ Signature of Applicant RECEIVED Town Clerk's ffice nfetgovan DATE: DEC 11 M7 nail Lid 17©W Me ;r• coc' Ci 4.1 O... •