HomeMy WebLinkAboutMartin OFFICE OF THE TOWN CLERK ' FO
Town of Southold C��FC�G
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road �� ,
P. 0. Box 1179 �, r) =x " . •
Southold, New York 11971 �\ � '=ty ••,
Telephone �( st
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 506 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: John J. Martin
OWNER MAILING ADDRESS: 5875 Peconic Bay Blvd.
Laurel, New York 11948
OWNER PROPERTY ADDRESS: 5875 Peconic Bay Blvd.
Laurel, New York •
•
OWNER TELEPHONE NUMBER: 516-298-5147
TAX MAP NO. : Section 128 Block 1 Lot
CROSS STREET: Birch Drive
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: 1977
dregaati:047,„
Judith T. Te ry
Southold Town Clerk
DATE: December 2, 1987
(TOWN SEAL) )
OFFICE OF THE TOWN CLERK c0Four
Town of Southold �� CQ ' . Application No. 1/45-6 F
Judith T. Terry, Town Clerk ‘%4 Ku __
Town Hall, 53095 Main Road y'.. '� Residential
°�,
P. O. Box 1179 an � Non-Residential
Southold, New York 11971 N- ••Telephone ielfe( it
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT •
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 0-06
Fee $ /d v
DATE /70--(/' 4 ✓917
OWNER NAME: o J, l 4PY,a, r-t .i
OWNER MAILING ADDRESS: 3f' 7,J le_ c-ow, I c, `lie¢-7 8wc
rQ /V- y p P'
OWNER PROPERTY ADDRESS: Sci. " --
OWNER TELEPHONE NUMBER: ? f ' 6-1-2/ 7
TAX MAP NO. : Section 9 Block ? Lot
CROSS STREET: ', rr-c l=, 'P Y
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool /' New Existing
Residential 1 Non-Residential
DATE OF PREVIOUS PUMP-OUT: / 9 77
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.)
Siiceie /272 6'1Z.d.
gna e of Applicant
RECEIVED BY: ‘: _ I
1.wn elerk's office
DATE: DEC 011987
icom clerk Southold
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