HomeMy WebLinkAboutHorton (3) OFFICE OF THE TOWN CLERK • •C��FFO�
Town of Southold o0
Judith T. Terry, Town Clerk z t
Town Hall, 53095 Main Road s% ��T,�� �, . A •
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P. p. Box 1179 u) �; �.,r, s�•• y�•�
Southold, New York 11971 Vi.
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Telephone �( iift
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 443 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool X
NAME OF OWNER: Richard L. Horton
OWNER MAILING ADDRESS: New Suffolk Lane
Cutchoque, New-York 11935
OWNER PROPERTY ADDRESS: New Suffolk Lane
Cutchogue, New York 11935
OWNER TELEPHONE NUMBER: 516-734-5927
TAX MAP NO. : Section 109 Block 6 Lot 10
CROSS STREET: Main Road (Rt. 25)
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
1,. / • • .. of
Judith T. erry
Southold Town Clerk
DATE: September 28, 1987
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK �c���F�(�•
Town of Southold �® CQ�' Application No. ' Y3
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road a _• ,_ �•G Residential
P. O. Box 1179 cr3 ' � Non-Residential
Southold, New York 11971 , �0 ��`
Telephone : .( q
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE (F7
OWNER NAME: /Tec , ' J 2.117/6/P7-Dir/
OWNER MAILING ADDRESS: flEW
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OWNER PROPERTY ADDRESS: 514
OWNER TELEPHONE NUMBER: 7 3 `5 02
TAX MAP NO. : Section Block Lot
CROSS STREET: ;� �� 7 Y)11 led-
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential 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: a
Town ilerl%elftZ
RICEIVED
DATE: , , •
Town MTh So d
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8-87 109-6-10
I Richard Hor--G _
New SuffolkANe [oe
Cutcho ue; N 1193
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