HomeMy WebLinkAboutLevien OFFICE OF THE TOWN CLERKFO
Town of Southold
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Judith T. Terry, Town Clerk � Mg. ,
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Town Hall, 53095 Main Road ;. 4�
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P. O. Box 1179 �
Southold, New York 11971 ;0 $ O�-
Telephone •
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(516)- 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 344 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool X
NAME OF OWNER: Charles S. Levien
OWNER MAILING ADDRESS: P.O. Box 992
Cutchogue, New York 11935
OWNER PROPERTY ADDRESS: Beebe Drive
Cutchogue, New YOrk
OWNER TELEPHONE NUMBER: 516-734-5445
TAX MAP NO. : Section 97 Block 7 Lot
CROSS STREET: Antler Lane
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: March 1987
Judith T. Terry
Southold Town Clerk •
DATE: July 15, 1987 -
- - (TOWN SEAL) - '
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OFFICE OF THE TOWN CLERK ci\VFair
Town of Southold �® CQ ',, Application No.395/
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road ;01 "� } Residential
P. O. Box 1179 �: Non-Residential
Southold, New York 11971 O ® � *-�`
Telephone 6.1
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee
$ /U
DATE /4) /4) 7
OWNER NAME: 0/4 CIS' ' e s kt/T«/I(
OWNER MAILING ADDRESS: p 6 a
- 7 OWNER PROPERTY ADDRESS: i
OWNER TELEPHONE NUMBER: .23 47 � 27'
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TAX MAP NO. : Section ' 97 Block 7 Lot
CROSS STREET: R /AN-7`I oP
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: -3 /(5)
7
LOCATION MAP: ` Must be attached_hereto before permit may be issued.
C )(Locate building and system; give north arrow and feet
® of distance, approximately, to building and closest road.)
OP/
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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POULS
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