HomeMy WebLinkAboutKing (6) P1" •
OFFICE OF THE TOWN CLERK • �FFO[/lr
Town of Southold �� C(l/
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Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road ,
P. O. Box 1179 �v' s;.•
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Southold, New York 11971 O�"® ��-
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Telephone �i
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 280 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: Marion R. King
OWNER MAILING ADDRESS: Box 1106
Southold, New Yo'rk 11971
OWNER PROPERTY ADDRESS: Main Road
Southold, New York
OWNER TELEPHONE NUMBER: 516-765-3069
TAX MAP NO. : Section 70 Block 1 Lot 3
CROSS STREET: Tuckers Lane
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: December 1986
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Judith T. Terry
Southold Town Clerk
DATE: April 22, 1987
(TOWN SEAL)
IS AI.
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OFFICE OF THE TOWN CLERK c�IFOtA'
Town of Southold � C�� Application No.rO O
Judith T. Terry, Town Clerk ) :',,,:13-'414,,,,
4� � � Residential
Town Hall, 53095 Main Road a -
P. 0. Box 1179 u' ,�� � J ,' Non-Residential
Southold, New York 11971 O ®_ #01
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. Telephone _�l ��.
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
- -- - for - -
OPERATION PERMIT -
SEPTIC TANK or CESSPOOL .
Operation Permit No.
Fee $ /4
. DATE ///174S7
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OWNER NAME: /1j 2
OWNER MAILING ADDRESS: 7 - ,
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, , OWNER PROPERTY ADDRESS: 4, ,',, ;„ gel-rte
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OWNER TELEPHONE NUMBER: —„.?e
TAX MAP NO. : Section 7,0 Block ' / Lot
CROSS STREET: 1� ,' ' Ae, , c
TYPE OF SYSTEM: Septic Tank New Existing d/
Cesspool New Existing V -
Residential V Non-Residential •
DATE OF PREVIOUS PUMP—OUT: _Mr -- /74--)7;
___,
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.)
4110 ....
Signature of App icant
RECEIVED BY: ( _ 09-6--,0.--,---)
Town CI k's Officgn
DATE: RECEIVED
APR 21 1987
Town Clerk Southold
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TO THIS SURVEY IS ANEWVIOLATION ST
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SECTION 7259 OF ThE NEW YORE STATE
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- • EDUCATION LAW OF '
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TUTIO,,, GUARANTEES A.;, ,v07 L.ANSFERAKE
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