HomeMy WebLinkAboutC&L OFFICE OF THE TOWN CLERK
Town of Southold , cV� COG
Judith T. Terry, Town Clerk _
Town Hall, 53095 Main Road 8 .
P. O. Box 1179 LI"
Southold,, New York 11971 4 - O .'
Telephone _4�! )0 '.
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. NR 8 Residential
Non-Residential xx
Fee $ 25.00
Septic Cesspool xx
NAME OF OWNER: C & L Realty Inc.
OWNER MAILING ADDRESS: Main Road
Southold, New York 11971
-OWNER ,PROPERTY--ADDRESS-: Main-Road --:(Ter--n ng-Point
Southold, New York
OWNER TELEPHONE NUMBER: 516-765-5121
TAX MAP NO. : Section 56 Block 6 Lot 3.4
CROSS STREET: Bay Home Road
TYPE OF SYSTEM: Septic Tank X New Existing XX
Cesspool x New - Existing xx
Residential Non-Residential xx
DATE OF PREVIOUS PUMP-OUT: August 1986
Judith T. Terr
Southold Town Clerk
DATE: September 19, 1986 -
(TOWN SEAL)
OFFICE OF THE TOWN CLERK c31FOur
°" - Ai g- -
Town of Southold gArki,
® 4 QG Application No._ -- _Judith T. Terry, Town Clerk % •': = - Residential ;- f
Town Hall, 53095 Main Road c
P. O. Box 1179 -pi,---,a ;
,�; Non-Residential
Southold, New York 11971 O "‘.
Telephone ®.( '�i` )\�� '.
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.', ��
Fee $ - . a6—
DATE7 7 7I9(3
OWNER NAME: G 4- L em..T 1( 170e:
OWNER MAILING ADDRESS: , ) go /p4D
•5r14-74bLb ( 1Oef f I f 17 f
OWNER PROPERTY ADDRESS: /'T$1 !1/4.3 ( -b 11�rn ,) P6LINfi l�1
S(714-7-1-60 ( /U4c 111 (
OWNER TELEPHONE NUMBER: 7'5 6---J 2
TAX MAP NO. : Section ,-, e Block 6 Lot 3
CROSS STREET: exp( a G- Rano
TYPE OF SYSTEM: Septic Tank !/ New Existing //�
Cesspool j, New Existing v
Residential Non-Residential /--------
DATE OF PREVIOUS PUMP-OUT: all ( 9 V,
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.)
1/ / j /*/
/ ignature o Applicant
RECEIVED BY:
Townk's Of ice
DATE: n �r�c� iCJ / 2, /`2 A