HomeMy WebLinkAboutSouthold Beach Motel •
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OFFICE OF THE TOWN CLERK FO
Town of Southold � COG
Judith T. Terry, Town Clerk �� �: �
461,
Town Hall, 53095 Main Road
P. O. Box 1179
Southold, New York 11971
Telephone -qt16
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER-DISPOSAL DISTRICT
OPERATION PERMIT .
SEPTIC TANK or CESSPOOL
Operation Permit No. NR50 Residential .
- Non-Residential. X
- Fee $ 25.00
Septic Cesspool X
- NAME OF. OWNER: Jean C. Leonard - Southold Beach Motel
OWNER MAILING ADDRESS: P.O. Box 741
Southold, New York 11971
OWNER PROPERTY ADDRESS: North Road
Southold, New York
OWNER TELEPHONE NUMBER: 516-765-2233
TAX MAP NO. : Section 52 Block 2 Lot ?
CROSS STREET: Carole Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential Non-Residential x
DATE OF PREVIOUS PUMP-OUT: July 1987
Judith T. Terr
Southold Town Clerk
DATE: August 25, 1987
'(TOWN SEAL)
ti
I OP so.,
OFFICE 'OF THE TOWN CLERK IcOFUCA- ��,,``
Town of Southold �� CDj'; Application No./l/eg-
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road {, 4 �G Residential
P. O. Box 1179 , O'; ;' Non-Residential
Southold, New York 11971 O ®, es
Telephone
(516) 765-1801
TOWN OF SOUTHOLD '
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. •
Fee $ 1-5-10)
DATE g-7i9,-- r
OWNER NAME: .C9-vA, e.. ` L t A-eLcL
OWNER MAILING ADDRESS:
OWNER PROPERTY ADDRESS: eiJ SV,. `141 ; k.4
G'4) . \--I t�
OWNER TELEPHONE NUMBER: 't L' 't I��� � -'-
L}
TAX MAP NO. : Section Block Lot
CROSS STREET: 1Le--
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool � New Existing
Residential Non-Residential
i r
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.)
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE: