HomeMy WebLinkAboutDruck OFFICE OF THE TOWN CLERKFO
Town of Southold D,� ; CSG
Judith T. Terry, Town Clerk ;% 4•
Town Hall, 53095 Main Road _ .
P. O. Box 1179 ,�
Southold, New York 11971 Q � 0•��`
Telephone .®1 le NW
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 444 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool X
NAME OF OWNER: James F. Druck 411
OWNER MAILING ADDRESS: Box 355
Laurel, New York 11948
OWNER PROPERTY ADDRESS: 7015 Peconic Bay Blvd.
Laurel, New York V
OWNER TELEPHONE NUMBER: 516-298-9384
TAX MAP NO. : Section 126 Block 10 Lot 13
CROSS STREET: Bray Avenue
,TYPE OF SYSTEM: Septic Tank X New Existing • x
Cesspool New Existing
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Never previously pumped
•
Judith T. Terry
Southold Town Clerk
DATE: September 28, 1987 -
(TOWN SEAL)
•
OFFICE OF THE TOWN CLERK .0 .4.
Town of Southold &;) CQ Application No. 941fri
Judith T. Terry, Town Clerk *` �►
Town Hall, 53095 Main Road F '� Residential
P. O. Box 1179 cn M " _ Non-Residential
Southold, New York 11971
Telephone = .( ',
•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
f C -
OPERATION PERMIT _
SEPTIC TANK or CESSPOOL
Operation Permit No. / (d(/ V
Fee $ /0
DATE 11 2A (. ''q*
•
OWNER NAME:.r 41.('VvG.sVc
OWNER MAILING ADDRESS: 13cA, 355 S S
Lcuorce N\-( \.146?
OWNER PROPERTY ADDRESS: .340(5 R.es.CPr& nuc 64,4,
-wY,e-e..„ I,
OWNER TELEPHONE NUMBER: 5-14 -- Z�L$ '—� g
TAX- MAP NO. : Secti&i ,\2-C2 Block to Lot l 3
CROSS STREET,: '27Yd.' E�C/hc� /50.41. 4/44-
TYPE
t -LTYPE OF SYSTEM:; Septic Tank' K New Existing
Cesspool New Existing ,
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: 15-
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.)
(.7/
Agte.rfc. A4ucarg‘rj
RECEIVED BY:
own Jerk's ffice
RECEIVED -
DATE:
SES'2 8 1987
/own CVOs Southold
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