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HomeMy WebLinkAboutHouse OFFICE OF THE TOWN CLERK Town of Southold Judith T. Terry, Town Clerk Town Hall, 53095 Main Road P. O. Box 1179 Southold, New York 11971 Telephone (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 13 Residential XXX Fee $ _ 10 . 0 0 Non-Residential Septic Cesspool XXX NAME OF OWNER: James ' & Carol Mouse OWNER MAILING ADDRESS: 29745 Main Rnad_ Cutchogue, New York 11935 -� OWNER PROPERTY ADDRESS: same ,`s ^�,;�., z OWNER TELEPHONE NUMBER: 734-6288 -"`'' ?"#•` TAX MAP NO. : Section 102 Block 2 Lot 13 CROSS STREET: Depot Lane/ Pequash Aven„P TYPE OF SYSTEM: Septic Tank New Existing Cesspool xxx New Existing xxx Residential XXX Non-Residential DATE OF PREVIOUS PUMP-OUT: August 1980 i Judith T. Terry Southold Town Clerk DATE: August 15 . 1986 (TOWN SEAL) OFFICE OF THE TOWN CLERK �•COFDC,r�"= I Town of Southold CQl/ Application No._ !3 Judith T. Terry, Town Clerk % � n rft" ;,. .4%4 Town Hall, 53095 Main Road o = . „Y '� Residential P. O. Box 1179 u-3 ,,21, 7 �: Non-Residential Southold, New York 11971 ® '`v •' Telephone _ 1 Y► (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ • DATE 01-7/16 OWNER NAME: . ,,,,ed eam-L ivf -e___OWNER MAILING DDRESS: 2_5`7(( 3> U( /,(A,1�Pei e_e, uer-L... 0 in/las-- OWNER n/las-- OWNER PROPERTY ADDRESS: Qa-7JI.--'2___� OWNER TELEPHONE NUMBER: Vie -T 3q -- 6-Les j TAX MAP NO. : Section C,d Z Block 2— Lot I `3 CROSS STREET: I J_Pf�d �—.C,�_e� P A a L, A/4_ v TYPE OF SYSTEM: Septic Tank New Existing X Cesspool New Existing Residential X Non-Residential DATE OF PREVIOUS PUMP-OUT:4-F OP/f. tr; 7e441,S 0) LOCATION MAP: Must be attached hereto before permit may be issued. (Locate building and system; give north arrow and feet of dist. —VO % approximately, to building and closest road.) 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