HomeMy WebLinkAboutChemical Bank OFFICE OF THE TOWN CLERKFU
Town of Southold , DOC��F
Judith T. Terry, Town Clerk Z ,:._ M fi . e
Town Hall, 53095 Main Road
P. O. Box 1179 �v' `•. �,'
Southold, New York 11971
Telephone 0(
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. NR 30 Residential
Non-Residential x
Fee $ 25.00
Septic Cesspool x
NAME OF OWNER: Chemical Bank c/o Real Estate & Corp. Services
OWNER MAILING ADDRESS: 633 3rd Avenue
New York, New York 10017
OWNER PROPERTY ADDRESS: 51300 Main Road
Southold, New York
OWNER TELEPHONE NUMBER: 212-878-3675
TAX MAP NO. : Section 61 Block 3 Lot 7
CROSS STREET: Wells Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential Non-Residential X
DATE OF PREVIOUS PUMP-OUT: None
0,reeodeZelLI.
Judith T. Terry
Southold Town Clerk
DATE: December 11 , 1986
(TOWN SEAL)
Si _ ._ —
,.��I
OFFIC OF THE TOWN CLERK �c.31HU'��,
Town of Southold �O CQG Application No. ;lea)
Judith T. Terry, Town Clerk £-•.}'' t=
Town Hall, 53095 Main Road "`+• r< ' Residential
it
P. O. Box 1179 w • � Non-Residential L._./Southold, New York 11971 O�O•.:-_ , �®�1
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 042D
r '
Fee $ a 5
DATE /1///g6
OWNER NAME: CAA-PM /CSL �/-}iU/C G 0 �ect e-sI
OWNER MAILING ADDRESS: 6 3 3 3 f'J
Al-eGu \1 o res 4 ,IUy /00/7
OWNER PROPERTY ADDRESS: j ( 3 UU /.4q i Al ( c.)ct c
Souf- hold /V `/ l/q 71
OWNER TELEPHONE NUMBER: a/ a - ' 7 p l s 6 `75
-'TAX MAP NO. : Section 6 7 Block Lot
CROSS STREET: k1,&C.., Si ',
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool g New Existing
Residential Non-Residential X
DATE OF PREVIOUS PUMP-OUT: p o t<
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.)
Signature of Applicant c
RECEIVED BY:
Town Clerk's Office
RECEIVE®
DATE:
1 0 I906
1Tom Clerk south 2 c' y 0C(