HomeMy WebLinkAboutHungerford OFFICE OF THE TOWN CLERK c�\
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Town of Southold �
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road g
P. O. Box 1179 :.
Southold, New York 11971 %4
Telephone :�/ s]►�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 19 Residential X
Fee $ 10 . 00 Non-Residential
Septic X Cesspool
NAME OF OWNER: Nancy & Robert Hungerford
OWNER MAILING ADDRESS: P . O . Box 2055
Orient , NY 11957
OWNER PROPERTY ADDRESS: Grandview Drive
Grandview Estates , Orient, New York
OWNER TELEPHONE NUMBER: 323-3982
,TAX MAP NO. : Section 14 Block 2 Lot 3 . 8
CROSS STREET: Old Main Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X - Non-Residential
DATE OF PREVIOUS PUMP-OUT: July 1986
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Judith T. Terry
Southold Town Clerk
DATE: August 19 , 1986
(TOWN SEAL)
of
OFFICE OF THE TOWN CLERK c�FFOUr
Town of Southold �� - CSG Application No. `//G'
Judith T. Terry, Town Clerk " ssk
Town Hall, 53095 Main Road c v *1. : ��I Residential
P. 0. Box 1179 ' >, ' : Non-Residential
Southold, New York 11971 O �`
•
Telephone SOl [ •
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ ;Je:3
DATE O •/3 • e5--
OWNER NAME: AM-NCal g��, T- , 4@
OWNER MAILING ADDRESS: '0 SOX O-9•—
p N7 Net ,/? i
OWNER PROPERTY ADDRESS: i 410'
OWNER TELEPHONE NUMBER: '04 - 3 7-3 — 31°8.
TAX MAP NO. : Section /I/ - lock Lot
CROSS STREET: (Uat L G.c; Ed,
TYPEOF SYSTEM: Septic Tank New Existing
Cesspool New Existing 7e—
Residential >& Non-Residential
DATE OF PREVIOUS PUMP-OUT: 7:///c6k4
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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Si dnat of Applicant
RECEIVED BY: eec_-
nn Town Cle, k's Offi e
DATE: /fX
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