HomeMy WebLinkAboutKnapp OFFICE OF THE TOWN CLERKOc���F,�11(K`,
Town of Southold Olj
Judith T. Terry, Town Clerk ' - -
Town Hall, 53095 Main Road c rt
P. O. Box 1179 cn -"
Southold, New York 11971 �0��•
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Telephone . s
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 59 Residential XX
Non-Residential
Fee $ 10.00
Septic Cesspool XX_
NAME OF OWNER: Nancy Knapp
OWNER MAILING ADDRESS: 1060 Little Peconic Bay Road
Cutchogue. New York 11935
-OWNER PROPERTY ADDRESS: '1-060 Little -Peconic Bay -Road
Cutchogue. New York 11935
OWNER TELEPHONE NUMBER: 516-734-6623
TAX MAP NO. : Section 111 Block 14 Lot 16
CROSS STREET: Haywaters Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool XX New Existing XX
Residential XX Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
Judi T. Terry
Southold Town Clerk
DATE: September 22, 1986
(TOWN SEAL)
OFFICE OF THE TOWN CLERK ‘C;
Town of Southold OHO C��', Application No.`
Judith T. Terry, Town Clerk m3 ', �7 Residential
Town Hall, 53095 Main Road 8 �-� -
P. O. Box 1179 c,n g : Non-Residential
Southold, New York 11971
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lephone 4,_ � `P`
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. L-6-Y
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Fee $ / 0
DATE
OWNER NAME: (\ ,c}I\J/'!.l ko 6t ,pp
OWNER MAILING ADDRESS: (-) A () L� p � �����;c :1\-- r r4 pad
08 « �► J� ��
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: -7 ,3 y" - j� (I Q3
TAX MAP NO. : Section / / ! Block f Li Lot / 4
CROSS STREET: H4/1 '/) 1-?rs Raa /
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool V New Existing X
Residential ;(- Non-Residential
DATE OF PREVIOUS PUMP-OUT: (<-,J kni.c}/d
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.)
Signat O re of A0gnt
RECEIVED BY. ac--G
Towr/Clerk's Office
DATE:
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