HomeMy WebLinkAboutEkster OFFICE OF THE TOWN CLERK
Town of Southold
Judith T. Terry, Town Clerk Z
Town Hall, 53095 Main Road 'mac
P. 0. Box 1179 U12
Southold, New York 11971 p • ®�-
Telephone �.( t
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 118 Residential
Fee $ 10.00
Non-Residential
� � '
Septic Cesspool X
NAME OF OWNER: Perry Ekster
OWNER MAILING ADDRESS: P.O. Box 64
New Suffolk, New York 11956
OWNER PROPERTY ADDRESS: New Suffolk Road
New Suffolk, New York
OWNER. TELEPHONE NUMBER: 516-734-5413
TAX MAP NO. : Section 117 Block 4 Lot �1
CROSS STREET: Orchard Street
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: July 1986
e
Judith T. TerrgV
Southold Town Clerk
DATE: November-3, 1986
(TOWN SEAL)
OFFICE OF THE TOWN CLERK .S�FF%/r
Town of SoutholdTown Clerk ® CQ A lication No/dI
Judith T. Terry, Residential idential
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Town Hall, 53095 Main Road c
P. 0. Box 1179 cn ' Non-Residential
Southold, New -York 11971 O ® _ Zr
Telephone ®( Zr
(516) 765-1801
avill TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
Igo some APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.�
Fee $ /0
DATE G ? �
1 _
OWNER NAME: I� 1 d--
OWNER MAILING ADDRESS:
OWNER PROPERTY ADDRESS:� „SSU }= t- d / /C
C
Ire cep _S' y r
OWNER TELEPHONE NUMBER: 7 4`^ S �
J TAX MAP NO. : Section / 7 d Block Lot 3 Q 0
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT:
LOCATION MAP: Must be attached hereto bed re permit may be issued.
(Locate building and system; give north arrow and feet
- - of distance,--approximately, .to building and closest road.)
Signature of App ' ant
RECEIVED BY:
Town CI k'sOffi e
DATE:—
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