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HomeMy WebLinkAboutJacobs (3) OFFICE OF THE TOWN CLERK ' 'cvFFfj . Town of Southold � CQG Judith T. Terry, Town Clerk ? � Town Hall, 53095 Main Road P. O. Box 1179 �u' Southold, New York 11971 O gib �'� Telephone _Q( O..... (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 41 Residential xx Non-Residential Fee $ 10.00 Septic Cesspool xx NAME OF OWNER: Raymond L. Jacobs OWNER MAILING ADDRESS: Main Road East Marion, New York 11939 OWNER PROPERTY ADDRESS: Main Road East Marion, New York OWNER TELEPHONE NUMBER: 516-477-1567 TAX MAP NO.,: Section 31 Block 2 Lot 28 CROSS STREET: Rocky Point Road TYPE OF SYSTEM: Septic Tank New Existing Cesspool XX New Existing xx Residential xx Non-Residential DATE OF PREVIOUS PUMP-OUT: June 3, 1986 aireseej::' Judith T. Terr Southold Town C erk DATE: September 10. 1986 (TOWN SEAL) , OFFICE OF THE TOWN CLERK COMA' Town of Southold CQ ' Application No. 1-7/ Judith T. Terry, Town Clerk (---/Town Hall, 53095 Main Road Residential p. O. Box 1179 _, , ' �� Non-Residential Southold, New York 11971 Telephone 4 AO e' (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL • Operation Permit No. LH Fee $ IO DATE /9----1 ---e?‘. ----/ —e? ' • OWNER NAME: OWNER MAILING ADDRESS: / G OWNER PROPERTY ADDRESS: fa ,r _. OWNER TELEPHONE NUMBER: //77— TAX 77 TAX MAP NO. : Section 3/ Block 2 Lot i a' CROSS STREET: / 4rdifrig'fre-`14 Ate? { TYPE OF SYSTEM: Septic Tank New Existing Cesspool V New Existing Residential tr Non-Residential DATE OF PREVIOUS PUMP-OUT: pj - , a.(6 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 ,_ . .licant RECEIVED BY: G dC Town Cle 's Offi DATE: ��� /O, I 8©'v nTRA P /FT- /6i( 4f R o?3