HomeMy WebLinkAboutHeggen OFFICE OF THE TOWN CLERK • cOFUL'
Town of Southold � s s��lj
Judith T. Terry, Town Clerk Z ;€x
Town Hall, 53095 Main Road s
P. O. Box 1179 ', ® � ' ~
Southold, New York 11971 \ r O� •
Telephone lC •
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 468 Residential x
Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: Lorna E. He.gen
OWNER MAILING ADDRESS: P.O. Box 391
Mattituck, New York 11952
OWNER PROPERTY ADDRESS: 15900 Main Road
Mattituck, New 'York -
OWNER TELEPHONE NUMBER: 516-298-8004
TAX MAP NO. : Section 315 Block 3 Lot 1 .3
CROSS STREET: Sunset Avenue
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool x New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
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Southold Towh' Clerk
•
DATE: October 19. 1987
(TOWN SEAL)
OFFICE OF THE TOWN CLERK Ci\VFD(ie' _ r/
Town of Southold �� . - -yCQ�' Application No. 4/64
Judith T. Terry, Town Clerk ; ,. �►
Town Hall, 53095 Main Road � , a. F+ ' } Residential
P. O. Box 1179 `" SA Non-Residential
Southold, New York 11971 O '(Z* ='" O
Telephone ®( N6N .�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE October 9, 1987
OWNER NAME: Lorna E. Heggen (Mrs. Willard J. Heggen)
OWNER MAILING ADDRESS: P. 0. Box 391
Mattituck, N. Y. 11952
OWNER PROPERTY ADDRESS: 15900 Main Road
Mattituck N. Y.
OWNER TELEPHONE NUMBER: 298-8004
TAX MAP NO. : Section 3 //5- Block 1 3Lot 3 3
CROSS STREET: Sunset Avenue
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool x New Existing x
Residential x Non-Residential
- DATE OF PREVIOUS PUMP-OUT: 9-17-87
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.)
- 44; ILA.
gnature of Applican#
RECEIVED BY:
Town Clerk's Office
DATE:
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