HomeMy WebLinkAboutLake OFFICE OF THE TOWN CLERK ec,Of
Town of Southold - y
Judith T. Terry, Town Clerk A
Town Hall, 53095 Main Road
P. 0. Box 1179 ® 44,7 - '�
Southold, New York 11971 ,
Telephone : 1i
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 235 Residential X
Non-Residential
Fee $ 10.00 Septic Cesspool x
NAME OF OWNER: Dorothy E. Lake -
OWNER MAILING ADDRESS: P.O. Box 127
New Suffolk, New York 11956
OWNER PROPERTY ADDRESS: 5980 New Suffolk Road
New Suffolk, New York
OWNER TELEPHONE NUMBER: 516-734-6900
TAX MAP NO. : Section 117 Block 4 Lot 35
CROSS STREET: George Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool x New Existing X
Residential x Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
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Judith T. Terr
Southold Town Clerk
DATE: March 11 , 1987
(TOWN SEAL)
OFFICE OF THE TOWN CLERK cOFOCr�'-
Town of Southold CD - Application No. �
Judith T. Terry, Town Clerk �� �`' e
Town Hall, 53095 Main Road c " ? "� Residential
P. O. Box 1179 � Non-Residential
Southold, New York 11971
Telephone -51‘e: .(
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
.3
Operation Permit No. --
Fee $ /0
DATE February 1, 1987
OWNER NAME: Dorothy E. Lake
OWNER MAILING ADDRESS: P.O. Box 127
OWNER PROPERTY ADDRESS: 5980 New Suffolk Rd.
New Suffolk, N.Y. 11956
OWNER TELEPHONE NUMBER: (516) 734-6900
TAX MAP NO. : Section 117. Block 4 Lot 35
CROSS STREET: George Rd.
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool x New Existing x
Residential x Non-Residential
DATE OF PREVIOUS PUMP-OUT: not known
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.)
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Si. ature of Applicant
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