HomeMy WebLinkAboutHawthorne OFFICE OF THE TOWN CLERK ' 'cOfO[r`,O
Town of Southold ,� l/y
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road •
P. O. Box 1179
Southold, New York 11971
Telephone �O` ��- •'
_ 0 A ��
(516) 765-1801 ' ',
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 223 Residential x
Non-Residential
Fee $ 10.00 Septic Cesspool x
NAME OF OWNER: EDWARD L. HAWTHORNE and HELEN D. HAWTHORNF
OWNER MAILING ADDRESS: P.O. Box 788
Cutchoque, New York 11935
OWNER PROPERTY ADDRESS: 2885 Haywaters Road. NassaupPoint
Cutchogue, New York
OWNER TELEPHONE NUMBER: 516-734-0800
TAX MAP NO. : Section 111 Block 7 Lot
CROSS STREET: Carrington Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: November 24. 1986
Judith T. Terr
Southold -Town Clerk
DATE: February 17- 1987
(TOWN SEAL)
` a
•' _
OFFICE OF THE TOWN CLERK ���•cvFFQ(,r���
Town of Southold CO Application No,c,?o2i3
Judith T. Terry, Town Clerk .% '`
53095 Main Road 4� :'� Residential
Town Hall, � 6,-..-,441
P. O. Box 1179 (r' i ; Non-Residential
Southold, New York 11971
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ ) V I®
DATE '' ' 415; tq 4,D
OWNER NAME: Lott a L, t+prurniviteKE. tri L%l� � Yprwrif-ortivr
OWNER MAILING ADDRESS: d 01 30
C-o-rc-7 6-v `,,ete I1935^
OWNER PROPERTY ADDRESS: 9,4391-c Yfr- w 'I'PAS ROM/ NA-95-AD Po, r
�-r C.-be .1/0--/, y 11R 35—
OWNER TELEPHONE NUMBER: 1 . 16) 7 ) t660
TAX MAP NO. : Section , If Block — '7 Lot
CROSS STREET: [Ale fatiNG-Td I( 1 W
� J
TYPE OF SYSTEM: Septic Tank New Existing
CesspooIC-'1 $ Not- New Existing F 1 `IIYOr
ResidentialS(paittGLki, Non-Residential
DATE OF PREVIOUS PUMP-OUT: )"a l0/ °' ! (p.1141,._
OCATION MAP:_ u .c,ed hereto before •ermitabeissued.
/k`p f.rrpetteD (Locate building and system; give north arrow and feet
btf� xkt-l1 of distance, approximately, to building and closest road.)
1065 rO t,kel
"St7-P
er
Signature of Applicant
RECEIVED BY:
Town Ierk's fice
DATE:
�S . ®T !!vts ®®x
{ - Q
S , ..l , ,% L.
SFcrtTia II- 8or8 lob C 95 P004
)-.OCPrTi pn! PA /' S*r't+I4 Piaox,ray f k
' LgiL....,k,0. Ogn.104 . Q ,
(Psr 514r
5/44S11A Sik °s
f''''''''I i'
O b' C ou .) g min ii,:.,1:,,.,
i Mfeo •qIirrin: te . rM
fit B- - tfitNtiorte
1_ 1
yvv5t. .3 .9.1sr
. 1
Roust revg• g.
afusammierames ' , _, 4 , .
y 3 ►`. \J
Zi ill'
1
4 v, k ' ' P11
3 i 7
- - WEN-rens Lor t X1,1
f+Prwrifts le 1.0r _. bIorit NAr } otie1Nf:ToN ,
/0a'X366N _ 1Ob' X 360' No. ,°.k' 1 ' >4360' ' (Gt7RNJn t-or too-)06o
94$5" y ttA-r t Ropz -
N -ss®►v Pp/yr
� 4-rava411°°' -9-J2415- 17p .
is
4 �ct OfgkPi17l°1 PEr1+r11'r 1