HomeMy WebLinkAboutKing (2) OFFICE OF THE TOWN CLERKFO
Town of Southold ���� �CD
Judith T. Terry, Town Clerk •
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Town Hall, 53095 Main Road a 4 k r
P. 0. Box 1179 Ur3 µ, ���•
Southold, New York 11971 p ®_ ° "._ Off.
Telephone i g ��
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 334 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool X
NAME OF OWNER: Hazel R. King
OWNER MAILING ADDRESS: Box 236
Peconic, New York 11958
OWNER PROPERTY ADDRESS: Indian Neck Lane
Peconic, New York 11958
OWNER TELEPHONE NUMBER: 516-734-6117
TAX MAP NO. : Section 86 Block 4 Lot 4
• CROSS STREET: Spring Lane
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: May 5, 1987
Judith T. Terry -
Southold Town Clerk
DATE: , July 15, 1987
(TOWN SEAL) -
L 7 -
335/
OFFICE OF THE TOWN CLERK ^ �'=
T.owri of Southold Application No.
Judith T. Terry, Town Clerk tretikA
Town Hall, 53095 Main Road r :C Residential >(
P. O. Box 1179 ' Non-Residential
Southold, New York 11971
Telephone _(// rzd IP;.
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
_for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. -
Fee $ •
DATE 9,61.4
/O) 19$7
•
OWNER NAME: 4-1 Az_d._ Kst°,3
OWNER MAILING ADDRESS: r\c:.1c4,re ex..K Lane y& a3te
Pe can't.e, / 1J.\). l Vi5g
OWNER PROPERTY ADDRESS: So -ne,'
OWNER TELEPHONE NUMBER: 7.39— 61 / 7
TAX MAP NO. : Section qi'--1 9 I Block % 4o, 41- Lot LLS• of I b
CROSS STREET: Seg;,. Lance
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: 5--J- 87
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.)
aLci,
Sigrtaeure of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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