HomeMy WebLinkAboutDickson OFFICE OF THE TOWN CLERK sc,OfeL i""---"ca_
Town of Southold � -_
Judith T. Terry, Town Clerk � _' 1�
Town Hall, 53095 Main Road ri
P. 0. Box 1179 .1.111 �
Southold, New York 11971 Q ,
Telephone 1 *i
(516) 765-1801 - -
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 618 Residential X
Non-Residential
Fee $ 10.00 Septic Cesspool X
•
NAME OF OWNER: Marjorie Penny Dickson
OWNER MAILING ADDRESS: Box 239
Cutchogue. New York 11935
OWNER PROPERTY ADDRESS: West Creek Avenue
Cutchogue. New York
OWNER TELEPHONE NUMBER: 516-734-5837 -
TAX MAP NO. : Section 110 Block 5 Lot 10
CROSS STREET: West Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X'
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Dec. 9, 1986
S .
—Judith T. Teiry
Southold Town Clerk
DATE: February 23, 1988
_(TOWN SEAL)