HomeMy WebLinkAboutHammond OFFICE OF THE TOWN CLERK � C FflLk ,OG
Town of Southold �
Judith T. Terry, Town Clerk ti sem y�
Town Hall, 53095 Main Road o ''
P. O. Box 1179 �cn ��
Southold,• New York 11971 \ Q ' ' •�
Telephone ,( t
(516) 765-1801 -
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation. Permit No. 609 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool x
NAME OF OWNER: George K. and Albert H. Hammond
OWNER MAILING ADDRESS: 3478 Brookside Road
Toledo, Ohio 43606
OWNER PROPERTY ADDRESS: Youngs Point Road
Mattituck, New York 11952
OWNER TELEPHONE NUMBER: 419-536-4471 -
TAX MAP NO. : Section 106 Block 12 Lot 3 2
CROSS STREET: Mill Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
droalletoonfoseje....
Judith T. T rry
Southold Town Clerk
1
DATE: February 16, 1988
•
-_(TOWN SEAL)
•
OFFICE OF THE TOWN CLERK ` RV( �c
Town of Southold �� e, Application No. 6pJ
Judith T. Terry, Town Clerk
� �� Residential �
Town Hall, 53095 Main Road
p. O. Box 1179 :x; Non-Residential
Southold, New York 11971 O ®, n,
Telephone .( -
•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE c2—,2—
OWNER
2—,2OWNER NAME: .. „" A./% _�-
OWNER MAILING ADDRESS: Li" 78 : / G1g
OWNER PROPERTY ADDRESS: �J R :� 440,401---
/v;.
/V
OWNER TELEPHONE NUMBER: (V/9J _414
TAX MAP NO. : Section /z6 Block /,2 Lot '5, -
CROSS STREET: '
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing 177
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.)
Si nature of Applicant
RECEIVED BY:
Town Crk's Of ice
DATE: �/( /
'Y
0,407
•�, ?anP
•
rA-
a/4;g HOM