HomeMy WebLinkAboutAdamson OFFICE OF THE TOWN CLERK riFOC,r
Town of Southold
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road '
P. O. Box 1179 '• f ' ' a
Southold, New York 11971 Q -r. o4c
Telephone 01 & l -`
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation. Permit No. NR57 Residential
Non-Residential X
Fee $ 25.00
Septic Cesspool x
NAME OF OWNER: WALTER ADAMSON
OWNER MAILING ADDRESS: 1770 Jacobs Lane
Southold, New York 11971
OWNER PROPERTY ADDRESS: Wayside Market - Main Road
Southold, New York 11971
OWNER TELEPHONE NUMBER: 516-765-3035
TAX MAP NO. : Section 62 Block 1 Lot 15
CROSS STREET: Boisseau Avenue
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
•
Residential Non-Residential X
DATE OF PREVIOUS PUMP-OUT: Unknown
Southold Town Clerk
DATE: December 31, 1987
(TOWN SEAL)
OFFICE OF THE ` OWN CLERK ��FIke
Town of Southold - �CQ Application No. //'s5
Judith T. Terry, Town Clerk . �� rte. i► .
Town Hall, 53095 Main Road
"�'"° ��r .•C � - Residential
P. -0. Box 1179 wNon-ResidentiaL.-
Southold, New York 11971
Telephone0!
(516) 765-1801
TOWN OF SOUTHOLD
•.. SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL •
Operation Permit No./VR(6-7
Fee $ p�5 °s •
DATE 42'Q 2'7. -
OWNER NAME: 6....,//11 7F / � 'Af /'
OWNER MAILING ADDRESS: /7,d \T-'/5 , 2 4 ,t) 4 "
, e-6 z ,Cy /19 7 /
OWNER PROPERTY ADDRESS: 1 "7,0 TfL /& � /S 144/1::
,14,4( -/7' �G /7 /li y l l •%' 7/
OWNER TELEPHONE NUMBER: 7‘ r
TAX MAP NO. : Section Block l Lot / 5
CROSS STREET: 1'l //V 1� .FD/J',f F,14' ,i
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool 2- . New Existing
Residential 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.)
ignature of Applicant
g
RECEIVED BY:
RFCEIVEDTown lerk's, 0 ice
DATE:
DEC 31t•
.i
1'nwn Clerk Southold
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