HomeMy WebLinkAboutKettrick OFFICE OF THE TOWN CLERK • IcsIFBUer, a
Town of Southold
Judith T. Terry, Town Clerk 4
Town Hall, 53095 Main Road
k, ,
P. O. Box 1179 "'
Southold, New York 11971 ',��0 *® O- .'
Telephone ' 0.( :P
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 151 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: Paul and Sarah Kettrick
OWNER MAILING ADDRESS: RR #2, 2565 Depot Lane
Cutchogue, New York 11935
OWNER PROPERTY ADDRESS: 2565 Depot Lane
Ciutchogue, New York
OWNER TELEPHONE NUMBER: 516-734-6217
TAX MAP NO. : Section 102 Block 1 Lot 8
CROSS STREET: School Street
TYPE OF SYSTEM: Septic Tank New Existing!
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknownt#44411;"°67.-4.1 .#'
Judith T. Terry
Southold Town Clerk
DATE: November 17, 1986
(TOWN SEAL)
•
OFFICE OF THE TOWN CLERK �FFO -_
Town of Southold �N� - Cy Application No. 45
Judith T. Terry, Town Clerk , . "° a
53095 Main Road „V- ` '< 7 Residential
Town Hall, o :.P. O. Box 1179 1 1 17- ti) Non-Resildential
Southold,Southold, New --York 11971 �'
Telephone sts,
(516) 765-1801
1
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. /51
Fee $
DATE /////re
OWNER NAME: /O, i,G 5,,04,9 rn 719k A
OWNER MAILING ADDRESS: 424 o I•
OWNER PROPERTY ADDRESS: 54e ' ,,¢rcn/E
OWNER TELEPHONE NUMBER: 71--4,07/
TAX MAP NO. : Section /Oa. Block 1 Lot 6
CROSS STREET: 560,0J 52-7
TYPE OF SYSTEM: Septic Tank New Existing Aga—
Cesspool New Existing
Residential )( Non-Residential
DATE OF PREVIOUS PUMP-OUT: tiA/4/4/e/A
LOCATION MAP: Must be attached hereto before permit may be issiu ed.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
"e141-eSignature of Applicant
RECEIVED BY: z , _, Ce¢ J
Town CI k's O ice
REEVED
DATE:
To Clerk Southold
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