HomeMy WebLinkAboutEpidy OFFICE OF THE TOWN CLERK C��FF01
Town of ,Southold 0�� COIj
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road
P. 0. Box 1179 Ln
Southold, New York 11971 4
TelephoneOl [
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 45 Residential XX
Fee $ 10.00 Non-Residential
Septic Cesspool xx
NAME OF OWNER: John and Koula Epidy
OWNER MAILING ADDRESS: P.O. Box 1007, Ruth Road
Mattituck, New York 11952
OWNER PROPERTY ADDRESS: Ruth Road
Mattituck, New York
OWNER TELEPHONE NUMBER:
TAX MAP NO. : Section 106 Block 5 Lot 27
CROSS STREET: - Breakwater and Aena Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool XX New Existing XX
Residential XX Non-Residential
-DATE OF PREVIOUS PUMP-OUT: Unknown
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Judith T. Terr
Southold Town Clerk
DATE: September 12, 1986
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(TOWN SEAL) ��
OFFICE 0jF THE TOWN CLERK
Town of Southold �Q CDG Application No.--
Judith
o.=Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road -� Residential
P. 0. Box 1179 ZF Non-Residential
Southold, New York 11971 O
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for '
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE
OWNER NAME: 1���'V /�t�(J ��>1
OWNER MAILING ADDRESS: C� , 0 X.
OWNER PROPERTY ADDRESS:, f
OWNER TELEPHONE NUMBER:
TAX MAP NO. : Section Block Lot
CROSS STREET: ����r,��
TYPE OF SYSTEM: Septic Tank I .ew Existing
v/
Cesspool ew Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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.)
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ignar, oft plicant
RECEIVED BY: �� _
Town lerk's Office RECEIVED
DATE:
SEP 12 1986
Town (;irk Southold