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OFFICE OF THE TOWN CLERK
Town of Southold �� Y CSG
Judith T. Terry, Town Clerk 'es• `
Town Hall, 53095 Main Road a K
P. O. Box 1179 cn
Southold, New York 11971 ��
1
Telephone N"'
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 62 Residential XX
Non-Residential
Fee $ 10.00 Septic Cesspool XX
NAME OF OWNER: Joseph N. Diaz
OWNER MAILING ADDRESS: 48 Wilmarth Avenue
Greenport, New York 11944
OWNER PROPERTY =ADDRESS: -48 _Wilmarth-Avenue
Greenport, New York 11944
OWNER TELEPHONE NUMBER: 516-477-1307
TAX MAP NO. : Section 41 Block 1 Lot 5
CROSS STREET: Booth Place
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool XX New Existing XX
Residential XX Non-Residential
DATE OF PREVIOUS PUMP-OUT: 1983
eiptv.
Judith T. Terry
Southold Town Clerk
DATE: September 23, 1986
(TOWN SEAL)
OFFICE OF THE TOWN CLERK .c31FE'(,+(�.-
Town of Southold 0�� ••-• -. . i4--- Application No.6
Judith T. Terry, Town Clerk �, I
Town Hall, 53095 Main Road Es.,,:_,- 4 € l Residential
P. O. Box 1179 u' j „- 4 ` Non-Residential
Southold, New York 11971 O0 •
$
Telephone e.� 44 1\
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. ��
Fee $ /0----
DATE 2/
OWNER NAME: O' S e ,0 /V, 9 /4
OWNER MAILING ADDRESS: e/r &%.//y4.2..7/ ,fc --P
( , oz7 N /. / .fy9'
OWNER PROPERTY ADDRESS: 5 /If ‘-i
OWNER TELEPHONE NUMBER: 4/77- /3017
TAX MAP NO. : Section // , —/-5 Block Lot ,3 c
CROSS STREET: -;EZ Fr.,
TYPE OF SYSTEM: Septic Tank/Ae4. 1 r ',w Existing z.-------'V
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: (4' ,7 - 6 -a_o- F
.e.. 47--...4
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' 0 1
illp ..t& .,e.A6
Si; ature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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