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OFFICE OF THE TOWN CLERK " ofgurC,OG
Town of Southold
Judith T. Terry, Town Clerk ?
Town Hall, 53095 Main Road = -
P. O. Box 1179 ��
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Southold, New ,York 11971 -0 ���-1•�
Telephone =�l •
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT •
SEPTIC TANK or CESSPOOL
Operation Permit No. 265 Residential X
Non-Residential
Fee $ 10:00
Septic Cesspool X
NAME OF OWNER: Warren and Ellen Rife
OWNER MAILING ADDRESS: Wells Avenue
Southold, New York 11971
OWNER PROPERTY ADDRESS: Wells Avenue
Southold, New York
OWNER TELEPHONE NUMBER: 516-765-1657
TAX MAP NO. : Section 70 Block 4 Lot 6
CROSS STREET: Oaklawn Avenue
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X • - New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: _ January 1987
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Judith T. Terry
Southold Town Clerk
DATE: April '7, 1987
(TOWN SEAL)
OFFICE OF THE TOWN CLERK �C��FF�(�•��`
Town of Southold �� r , CSG'_, Application No. a�e
Judith T. Terry, Town Clerk .� "? r�3F 4:
Town Hall, 53095 Main Road c . ; ,
Residential
P. O. Box 1179 � `
%x, 6
.� z Non-Residential
Southold, New York 11971 �w�,_" _.�0�•�
Telephone '`x90
•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 6,6-1
Fee $ (3 0 0
DATE X/7.47
OWNER NAME: reY1 E J ( n kJ
OWNER MAILING ADDRESS: vU E., I (
S,, E-1\.01 a(i N j /t cq7
OWNER PROPERTY ADDRESS: SQ„n�
OWNER TELEPHONE NUMBER: 7 S' I to s
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•TAX MAP NO. : Section ( U Block Y Lot
CROSS STREET: OCLV 1Crui
TYPE OF SYSTEM: Septic Tank ? New Existing U
Cesspool New Existing /V--
Residential
/Residential (7- Non-Residential
DATE OF PREVIOUS PUMP-OUT: pi_A/\_, )
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: , Lam/
Town rk's Office
DATE:
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