HomeMy WebLinkAboutHelies OFFICE OF THE TOWN CLERK ' c31FO(r ,'
Town of Southold CSG
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road
P. O. Box 1179
Southold, New -York 11971 ;4~y� 0• *$
Telephone _-��1 41 , `0
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 70 Residential XX
Non-Residential
Fee $ 10.00
Septic Cesspool XX
NAME OF OWNER: Brenda Helies
OWNER MAILING ADDRESS: 45 Shady Hill Road
Weston, MA 02193
OWNER- PROPERTY-ADDRESS: -;,Private,- Roadway, REdwood Cottage, Maratooka Point
Mattituck, New York
OWNER TELEPHONE NUMBER: 617-237-6873
TAX MAP NO. : Section 123 Block 8 Lot 28.3
CROSS STREET: Park Avenue
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool XX New Existing XX
Residential XX Non-Residential
DATE OF PREVIOUS PUMP-OUT: August 1986
6004;els:-.1.1=:"
Judith T. Terry
Southold Town Clerk
DATE: September 24, 1986
(TOWN SEAL)
SO
OFFICE OF THE TOWN CLERK �FF0(,r��=
Town of Southold ��� v CQG Application No. '7D
Judith T. Terry, Town Clerk '' y
Town Hall, 53095 Main Road ~ ` Residential
crs i `
P. O. Box 1179 Non-Residential
� . �,��.
Southold, New York 11971 O •
Telephone : 1 Y►
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
RECEIVED
SEP 2 4 1986 APPLICATION
Town Clerk Sofor
Southold
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 70
Fee $
DATE 7770/496
OWNER NAME: 8t 4ct i � 1i-es
OWNER MAILING ADDRESS: f,j Ekaair ,<jV! A
pric(zszPc 0-23 T-3
OWNER PROPERTY -ADDRESS: ReokO / 1'C''i kra)`-tied
/ cj 7`c���o JVD
OWNER TELEPHONE NUMBER: C't7-287-6,52:3
/625/
TAX MAP NO. : Section �crctEeol Block ? Lot c›2 if, 3
CROSS STREET: C Z e
TYPE OF SYSTEM: Septic TankNew Existing
Cesspool '. // New Existing _
Residential .O 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.)
Signature of Applicant
RECEIVED BY: CYi.�, n , Gty--b.. i
Town o J'erk's Office
DATE: c /5
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