HomeMy WebLinkAboutHansen OFFICE OF THE TOWN CLERK • FE COG
Town of Southold ���
Judith T. Terry, Town Clerk }_t.4" '
Town Hall, 53095 Main Road
P. O. Box 1179 Lrlli ' 'i g
Southold, New York 11971 p " . r� . `,
Telephone ��
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 346 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool X
NAME OF OWNER: Edward Hansen
OWNER MAILING ADDRESS: Box 136C, Cox Lane
Cutchogue, New York 11935
OWNER PROPERTY ADDRESS: Cox 'Lane
Cutchogue, New YOrk 11935
OWNER TELEPHONE NUMBER: 516-734-5232
TAX MAP NO. : Section 96 Block 3 Lot 8
CROSS STREET: Between Main Road and NOrth Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIQUS,PUMP-OUT: Approx. 9/80 "
Judith T. Terry
' Southold Town Clerk
DATE: July 15, 1987
(TOWN SEAL)
OFFICE, OF THE TOWN CLERK c��FF�(�i`, �G
Town of Southold �O • QG Application No. ST,
Judith T. Terry, Town Clerk .� ;.
a �G 1 Residential
Town Hall, 53095 Main Road : ,.
P. O. Box 1179
crs " = Y. hi Non-Residential
Southold, New York 11971 Oc
Telephone _o.( 41N�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE JUL/ qt 01
OWNER NAME: r 4 oo,rck c,tl)if�2
OWNER MAILING ADDRESS: o.0 C6LO,�a?
tilk(\(-)0 cAuLe vIce)5
OWNER PROPERTY ADDRESS: C e
OWNER TELEPHONE NUMBER: 31-+ I 3
TAX MAP NO. : Section to Block Lot
CROSS STREET:
TYPE OF SYSTEM: Septic Tank / New Existing
Cesspool J New Existing
g
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: — c� .,C . �O
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.)
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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