HomeMy WebLinkAboutHalliwell OFFICE OF THE TOWN CLERK I °c)�FFO(�C�
Town of Southold � 11:41- fy
Judith T. Terry, Town Clerk • ; ,
Town Hall, 53095 Main Road ^ =o t.t :
P. 0.. Box' 1179 ® ' =
Southold, New York 11971
Telephone ®4'
(516) 765-1801 ' -
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 359 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool. X
NAME OF OWNER: Donald A. Halliwell
OWNER MAILING ADDRESS: 36 Sunset Lane
Greenport, N.Y. 11944
OWNER PROPERTY ADDRESS: Same
OWNER TELEPHONE NUMBER: 477-1662
TAX MAP NO. : Section 33 Block 4 Lot 67
CROSS STREET: Sutton P1.
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: 4/6/87
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Judith T. ;Terra
Southold Town Clerk .
DATE: July 23, 1987
• ' (TOWN SEAL)
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OFFIC. OF THE TOWN CLERK COW
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T&wn of Southold CSG Application No.
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road ,' } Residential
P. O. Box 1179 � '.. _: ' � Non-Residential
Southold, New York 11971 O __ ��`
Telephone _ei �� •
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.L.3699'
•
Fee $ D D�
DATE /la.../e7
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OWNER NAME: af71•01L) A A . 1- I3 LLlu ELL
OWNER MAILING ADDRESS: 3 (, Hint SET
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OWNER PROPERTY ADDRESS: 36 3(46-LE 1.19cJ
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OWNER TELEPHONE NUMBER: `Fin b 7 -
TAX MAP NO. : Section L23 Block Lot 7
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CROSS STREET: _5 s- 1:6 h per ,
TYPE OF SYSTEM: Septic Tank / New Existing
Cesspool V New Existing V
Residential V Non-Residential
DATE OF PREVIOUS PUMP-OUT: 11/41/4,
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.)
4axi a.Qd
Signature of Applicant
RECEIVED BY: Lr4n C erk's ffice
DATE: 7/c3WA
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