HomeMy WebLinkAboutDickinson OFFICE OF THE TOWN CLERK • fQ
Town of Southold c��FC�G
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Judith T. Terry, Town Clerk tth
Town Hall, 53095 Main Road �„
P. 0. Box 1179 i v` _ M, K
Southold, New York 11971 ` Q ® �- •• '
Telephone __OI % '
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 442 Residential x
Fee $ 10.00 Non-Residential
Septic Cesspool x
NAME OF OWNER: Wesley Dickinson
OWNER MAILING ADDRESS: Bayview Road
Southold, New York 11971
OWNER PROPERTY ADDRESS: Bayview Road
Southold, New York
OWNER TELEPHONE NUMBER: 516-765-5762
TAX MAP NO. : Section 78 Block 9 Lot 30.1
CROSS STREET: Cedar Lane
TYPE OF SYSTEM: Septic Tank New " Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: None
ofgeo• .moi
• Judith T. T y
Southold Town Clerk
n DATE: September 28, 1987,
(TOWN SEAL)
OFFICE OF THE TOWN CLERK _r •S\\FFDi' r. • y�o�
Town of Southold Application No.
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road -; ' Residential
P. O. Box 1179 v' Non-Residential
Southold, New York 11971 O S, " 1�
Telephonec'4 411
(516) 765-1801
RECEMTOWN OF SOUTHOLD
SEP 181987 SOUTHOLD WASTEWATER DISPOSAL DISTRICT
Town Clerk Southold APPLICATION
tor
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. y��
Fee $ iO OO
DATE
OWNER NAME: rilVedEy `agt-a603r4
reayaisal GRgia
OWNER MAILING ADDRESS: go)lfIofd, , ltp
OWNER PROPERTY ADDRESS: A o \lc
OWNER TELEPHONE NUMBER: 14 S S7
TAX MAP NO. : Section 7 Block 9 Lot 2 . r
CROSS STREET: L Di+/t LA/de-
TYPE
/4J,dcTYPE OF SYSTEM: Septic Tank New Existing V
Cesspool New Existing
Residential ✓ Non-Residential
DATE OF PREVIOUS PUMP-OUT: N1 /J6
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.)
_. ,
Si. ature of Applicant
RECEIVED BY: <<_ce-e,..9
p
RECE@ wn C erk's ffice
DATE: SEP 281QE17
Town Clerk Southold
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