HomeMy WebLinkAboutLuce OFFICE OF THE TOWN CLERK 6
Town of Southold
•
Judith T. Terry, Town Clerk _• Gy
Town Hall, 53095 Main Road •
P. O. Box 1179 �� F` r
Southold, New York 11971 tip Off- !�
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Telephone .( * lb
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 252 Residential
Non-Residential
Fee $ 10.00
Septic Cesspool X
NAME OF OWNER: Flora S. Luce
OWNER MAILING ADDRESS: P.O. Box 934
Cutchogue. New York 11935 •
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OWNER PROPERTY ADDRESS: 505 Skunk Lane
Cutchogue. New York 11435
OWNER TELEPHONE NUMBER: 516-734-6024
TAX MAP NO. : Section 97 Block 4 Lot 3
CROSS STREET: Main Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: December 5, 19867
Ju•ith T. Tem'"
Southold Town C erk
DATE: March 31 . 1987
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK c,�FFO(,r.'=
Town of Southold �� CQ Application No6�-
Judith T. Terry, Town Clerk . '
Town Hall, 53095 Main Road o ' Residential
P. O. Box 1179 cn '` ` witi z Non-Residential
Southold, New York 11971 Ocil
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Telephone
(516) 765-1801 1 ;-' :�•
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.c? --
Fee $ /a;
DATE / 1)47,r7
OWNER NAME: V -ee_, .
OWNER MAILING ADDRESS: p.6.
OWNER PROPERTY ADDRESS:
, J/ (?,66
N
OWNER TELEPHONE NUMBER: ...f/ I - _ ,O a y
TAX MAP NO. : Section cJ Block e/ Lot 02 ¢J
CROSS STREET: '
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential x Non-Residential
DATE` OF PREVIOUS PUMP-OUT: /9-2,,c,, / 9e
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.)
Sig mature Applicant
RECEIVED BY:G4vyc-G{cc_ ,
R C ,yEgown rk's Office
DATE: fVL4R 3 a L0,,7
Town Clp.rk Southold
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