HomeMy WebLinkAboutKing (3) OFFICE OF THE TOWN CLERK
Town of Southold
Judith T. Terry Town Clerk ' '
Town Hall, 53095 Main Road o
P. O. Box 1179 �,� 2 gam!x: g
Southold, New York 11971 & ® L" �-
Telephone ^ o.,( i `�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation. Permit No. 564 Residential x
Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: James King
OWNER MAILING ADDRESS: 220 East Mill Road
Mattituck. New York 11952
OWNER PROPERTY ADDRESS: 220 East Mill Road
Mattituck. New York •
OWNER TELEPHONE NUMBER: 516-298-4718
TAX MAP NO. : Section 106 Block 4 Lot 6
CROSS STREET: Reeve Avenue
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool x New Existing x
Residential x Non-Residential
DATE OF PREVIOUS PUMP-OUT: 1986 - •
Judith T. Terry
Southold Town Clerk
DATE: January 8. 1988
(TOWN SEAL)
Y • its
OFFICE OF THE TOWN CLERK �c��FFO(�(�.
Town of Southold &o z �Q� Application No. �6 SC
Judith T. Terry, Town Clerk ` ,....; #a,,,c;.Y.�
Town Hall, 53095 Main Road s:..:- •` Residential
cn
P. O. Box 1179 i Non-Residential
Southold New York 11971 � 4. 4`� *.
Telephone .5f49-; ,
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
- - for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 570 7
Fee $ /0 — ,
DATE UJB'°` 7 :'
OWNER NAME: cJa,}-r�--, iti-/6
OWNER MAILING ADDRESS: 2 20 , /--t-i mi-' gic9_.
OWNER PROPERTY ADDRESS : M n- r i y—c/ C /C /, Y--
OWNER
OWNER TELEPHONE NUMBER: P_-9 f`' 4-A-7/ 8
TAX MAP NO. : Section /0 G Block Li Lot 6
CROSS STREET: fee6VE /}V/T
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing 1.------
Residential L Non-Residential
DATE OF PREVIOUS PUMP-OUT: fest- L -- %” Ce
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.)
24'.. -v--1' ,.e7""
e
Signature of Applic t
RECEIVED BY:(4e.,--xe.1_,
Town Clerk's fice
DATE: ii€Cj ' ce
JAN 0? 1987
Tnwn Merl( Southold
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