HomeMy WebLinkAboutJefferson OFFICE OF THE TOWN CLERK 'rAdFOUr`,
Town of Southold
Judith T. Terry, Town Clerk ; Z �.A-s
Town Hall, 53095 Main Road
P. O. Box 1179
Southold, New York 11971 �`�Q '� ' -,. 0� •'
Telephone _Q( i
(516) 765-1801 ''-
TOWN OF SOUTHOLD
•
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
• Operation Permit No. 158 Residential X
Non-Residential
• Fee $ 10.00
Septic Cesspool X
NAME OF OWNER: Mary L. Jefferson
OWNER MAILING ADDRESS: County Road 48, P.O. Box 438 t. '.
Cutchoquey New York 11935 -
OWNER PROPERTY ADDRESS: County Road 48
Cutchoque, New York ;
OWNER TELEPHONE NUMBER: 516-734-6938
TAX MAP NO. : Section 101r) Block 1 Lot 11
CROSS STREET: Alvahs Lane
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: July 14, 1986
•
Judith T. Ter •
Southold Town Clerk
DATE: November 28, 1986 •
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK COFDUI'
Town of Southold zS �Q Application No. /s/
Judith T. Terry, Town Clerk .� z K ►
Town Hall, 53095 Main Road
L 1 Residential
P. O. Box 1179 tr. i��' Non-Residential
Southold, New York" 11971 ���`
14,
Telephone -Y41
(516) 765-1801 -
TOWN OF SOUTHOLD
RIMPIA® SOUTHOLD WASTEWATER DISPOSAL DISTRICT
NOV 18 ES
APPLICATION
Ion MTh %AA
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. /3
Fee ,$ /0,00
DATE 11/14/86
OWNER NAME: Many L Je{64en3on
OWNER MAILING ADDRESS: County Road 48 PO Box 438
OWNER PROPERTY ADDRESS: tamp
OWNER TELEPHONE NUMBER: (516) 734-6938
TAX MAP NO. : Section /0/ Block / Lot 1/
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool y New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: ddy
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 Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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UNAUTHORIZED ALTERATION OR A9DIT
ICSIN•
I - TO THIS SURVEY IS A VIOLATION OF
S SECTION 72C9 OF ThE NEW YORE STIP
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