HomeMy WebLinkAboutHorton (2) OFFICE OF THE TOWN CLERK ' .c.31FOC,(- -
Town of Southold CSG
Judith T. Terry, Town Clerk * i
Town Hall, 53095 Main Road 8 ,x
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P. O. Box 1179 - c _'=
Southold, -" ~' ,
New York 11971 �•��
Telephone � 131 � '
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 27 Residential xx
Non-Residential
Fee $ 10.00
Septic Cesspool xx
NAME OF OWNER: James P. Horton
OWNER MAILING ADDRESS: P.O. Box 94, 745 New Suffolk Road
Cutchogue, New York 11935
OWNER PROPERTY ADDRESS: 745 New Suffolk Road
Cutchogue, New York
OWNER TELEPHONE NUMBER: 516-734-6654
TAX MAP NO. : Section 109 Block 7 Lot 4.01
CROSS STREET: Main Road (Route 25)
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool xx New Existing xx
Residential xx Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
Judi "Terry
Southold Town CI k
DATE: August 25, 1986
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK cvFFU(ir
Town of Southold �� ea % Application No. .27
Judith T. Terry, Town Clerk `) Residential (--7
Town Hall, 53095 Main RoadP. O. Box 1179 ter" 4 ` Non-Residential
Southold, New York 11971 ® ® �0 ,�`
Telephone : .I tc ,
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ i :9 °c
DATE C4'(74.../ E*6
OWNER NAME: (62/ ( - P/1/6/ 12/?7 ,1"
OWNER MAILING ADDRESS: -. � ✓/� G�
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OWNER PROPERTY ADDRESS: 71A-'
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OWNER TELEPHONE NUMBER: 57&'--- ,ers — 636
TAX MAP NO. : Section / C-/ Block '‘.7 Lot
CROSS STREET: ( 7 , c,/
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Resintial
DATE OF PREVIOUS PUMP-OUT: ��� G ( 67@
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.)
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Signature of Applicant
RECEIVED BY:
Town CI 's Offi
DATE012
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