HomeMy WebLinkAboutLevey OFFICE OF THE TOWN CLERK F01
Town of Southold
Judith T. Terry, Town Clerk -! � �� •
Town Hall,- 53095 Main Road
P. O. Box 1179 n •
Southold, New York 11971
Telephone of
(516) 765-1801 -
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL. DISTRICT
OPERATION "PERMIT
SEPTIC TANK or CESSPOOL
Operation, Permit No. 415 y -Residential X
Non-Residential
- " Fee $ 10.00
Septic Cesspool X
' NAME OF OWNER: Marc and Beverly Levey
OWNER MAILING ADDRESS: P.O. Box 812
Cutchoque, New York 11935 ;G
OWNER PROPERTY ADDRESS: 895 Highland Road
Cutchoque, New York
OWNER TELEPHONE NUMBER: 516-734-5197
TAX MAP NO. : Section 102 - Block 8 Lot 2
CROSS STREET: Spur Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New X Existing
Residential X Non-Residential -
DATE OF PREVIOUS PUMP-OUT: New System - Construction Permit No. 203
Judith T. Term
Southold Town Clerk
DATE: . August 28, 1987 -
- i
(TOWN SEAL)-
, r
OFFICE OF THE TOWN CLERK C0Fitir
Town of Southold , CQ ' Application No. /I
st
Judith T. Terry, Town Clerk �` "xtiV A ` �►
Town Hall, 53095 Main Road Residential
P. O. Box 1179 crs Non-Residential
Southold, New York 11971
Telephone 70 git *6\,)‘,'
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE August 26, 1987
OWNER NAME: Marc and Beverly Levey
OWNER MAILING ADDRESS: P.O. Box 812, Highland Road •
Cutchogue, New York 1193.5
- OWNER PROPERTY ADDRESS: 895 Highland Road
Cutchogue, New York 11935
OWNER TELEPHONE NUMBER: (516) 734-5197
TAX MAP NO. : Section 102 Block 8 Lot 2
CROSS STREET: 'Spur Road
TYPE OF SYSTEM: Septic Tank ?= New '` Existing
Cesspool X New X Existing
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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.)
Signature ofplicant
RECEIVED BY:
Town Clerk's Office -
DATE: