No preview available
HomeMy WebLinkAboutHughes u4 OFFICE OF THE TOWN CLERK • •c�� FULic" Town of Southold Judith T. Terry, Town Clerk ` { ' Town Hall, 53095 Main Road -r P. O. Box 1179 % carp Southold, New York 11971 Q�l0N- •� Telephone (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 178 Residential X Non-Residential Fee $ 10.00 Septic Cesspool X NAME OF OWNER: Lawrence J. Hughes OWNER MAILING ADDRESS: 7160 Horton I ane Southold. New Yri'rk 11971 OWNER PROPERTY ADDRESS: 7160 Horton I ane Southold, New York_ OWNER TELEPHONE NUMBER: 516-765-2748 • TAX MAP NO. : Section 54 Block 3 Lot 2,' CROSS STREET: SoundView Avenue TYPE OF SYSTEM: Septic Tank New Existing Cesspool X New Existing x Residential X Non-Residential DATE OF PREVIOUS PUMP-OUT: Unknown Judith T. Te Southold Town Clerk DATE: December 15, 1986 (TOWN SEAL) J I OFFICE OF THE TOWN CLERK1FO Town of Southold ���TM} CQG' Application No. /2L Judith T. Terry, Town Clerk 4 c Town Hall, 53095 Main Road ' 4 �c I Residential X P. O. Box 1179 1.11 t ,# ' �.` Non-Residential Southold, New York 11971 ® o0O��J Telephone .( '0 • (516) 765-1801 • TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ /0 DATE - /J;?- / n:/ OWNER NAME: � " o�'`�" r OWNER MAILING ADDRESS: 2/ d c"4' //7.71 747 OWNER PROPERTY ADDRESS: ---e-----01-1 � �-- OWNER TELEPHONE NUMBER: 7 b J Y717/ 1 TAX MAP NO. : Section ,S``7'/ Block C3 Lot /(72----/ CROSS STREET: TYPE OF SYSTEM: Septic Tank New Existing Cesspool i/"/ 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.) cat Signatu of Applicant RECEIVED BY: Town/Clerk' Office DATE: tt�� Iowa omit Southold -r-N ' ti4 \'4 A \P 5 ... i e cSi)0 / , -> 0 n ' Cr, 0( ,.I. (L, 1 44--- '.1 loig rOV /}` ; 7 cy \Ai v- . , T! ;'' r‘;',