HomeMy WebLinkAboutDigons OFFICE OF THE TOWN CLERK 6 IRV(`Olj
Town of Southold
Judith T. Terry, Town Clerk
Town Hall, 53095 Main RoadY
P. O. Box 1179 �cnM � > �.
Southold, New York 11971 O ®
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 102 Residential X
•
Fee $ 10.00 Non-Residential
Septic Cesspool x
NAME OF OWNER: Elsie Dillons
OWNER MAILING ADDRESS: Box 963
Mattituck, New YOrk 11952
OWNER PROPERTY ADDRESS: 1080 Deephole Drive
Mattituck, New York
OWNER TELEPHONE NUMBER: 516-298-4369
TAX MAP NO. : Section 115 Block 12 Lot 15
CROSS STREET: New Suffolk Avenue
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X:: New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: July 1985
Judith T. Terry
Southold Town Cler
DATE: October 21 , 1986
(TOWN SEAL) •
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OFFICE OF THE TOWN CLERK �c,�FFO(,(�'-
Town of Southold % CQG'; Application No. 102----'
Judith T. Terry, Town Clerk �� i -`
Town Hall, 53095 Main Road a fit:
� -� ; :_ Residential
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P. 0. Box 1179 wty ' �- : �, Non-Residential
Southold, New -York 11971 O ® f . -
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Telephone • "0.( , ��� .•
(516) 765-1801
RECEVED TOWN OF SOUTHOLD
OCT 2.1. 1986 SOUTHOLD WASTEWATER DISPOSAL DISTRICT
Tnw i Clerk Southold
APPLICATION
for _ -
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operati'oon, Permit No. /0(72--
Fee $ /opP-72
DATE /� f,44
OWNER NAME: a ,' % "; I
if
OWNER MAILING ADDRESS: AO /
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// y 71// ir /1 yo--.2,
OWNER PROPERTY ADDRESS:
t7etej ,r / -.to',,,CIA/ i
--Aet&kA ')j ?t `' 9ciroL
OWNER TELEPHONE NUMBER: n. �f�- -j'C 6 9'
TAX MAP NO. : Section //(5" Block /� Lot A5---
CROSS
`5CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential V Non-Residential
C DATE OF PREVIOUS PUMP-OUT: 7 ifC
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.)
_ ____ ____
di. ® 4 t+ � /rte:. /
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Signature of Applicant
RECEIVED BY: C -v4.2z_ )
Town Cl k's Offi e
DATE: 02-- _ / ( /PA
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