HomeMy WebLinkAboutJones OFFICE OF THE TOWN CLERK • IcOFUCKelG
Town of Southold • ' • � •- y ,
Judith T. Terry, Town Clerk Y ,°
Town Hall, 53095 Main Road
P. O. Box 1179 to f` -
Southold, New York 11971 >•���-
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Telephone � ,(
(516) 765-1801 '-
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL-DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
•
Operation Permit No. 318 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool x
•
NAME OF OWNER: Ruth Jones
OWNER MAILING ADDRESS: 1250 Founders Path
Southold, New York 11971
OWNER PROPERTY ADDRESS: 1250 Founders Path
Southold, New York
OWNER TELEPHONE NUMBER: 516-765-3148
TAX MAP NO. : Section 64 Block 4 Lot 3 f 6
• CROSS STREET: Landon Lane
TYPE OF SYSTEM: Septic Tank New Existing
• Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: . UNKNOWN
Judith T. Terr -
Southold Town Clerk
DATE.: July 13, 1987 •
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• (TOWN _SEAL)
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OI'FICE" OF THE TOWN CLERK cFOLA,
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Town of Southold . CQG • Application No2`f
Judith T. Terry, Town Clerk ��
Town Hall, 53095 Main Road c Residential
P. O. Box 1179 c.r' ':'�i ► Non-Residential
Southold, New York 11971 0 Zlio �
Telephone _ It
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /D
DATE
OWNER NAME:
OWNER MAILING ADDRESS: 12T
50-1-4it-04 )11
OWNER PROPERTY ADDRESS: Ljf9-f E
OWNER TELEPHONE NUMBER: -7 5-- 5 �y
TAX MAP NO. : Section 7 Block .49Lot 3 y`'
CROSS STREET: � � 0
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool t/ New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: (r�(447,{
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 pplicant
RECEIVED BY: •
Town Clerk's Office
DATE:
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