HomeMy WebLinkAboutRaynor Suter OFFICE OF THE TOWN CLERK • •cA "
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Town of Southold
Judith T-. Terry., Town Clerk V`? 4 w � 4V4
Town Hall, 53095 Main Road v 47,
P. 0. Box 1179 ,� .�
Southold, New York 11971 ' -r •
Telephone V1 131
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. NR56 Residential
Non-Residential x
Fee $ 25.00
Septic Cesspool x
NAME OF OWNER: Raynor-Suter Servistar Hardware
OWNER MAILING ADDRESS: 320 Love Lane '
Mattituck, New York 11952
OWNER PROPERTY ADDRESS: 320 Love Lane
Mattituck, New York
OWNER TELEPHONE NUMBER: 516-298-8420 •
TAX MAP NO. : Section 140 Block 3 Lot A--3,3
CROSS STREET: Pike Street
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool _ X New Existing x
Residential Non-Residential x
DATE OF PREVIOUS PUMP-OUT: Unknown
rrdith -7474
Southold Town Clerk •
DATE: December 29, 1987
•
(TOWN SEAL)
OFFICE :OF THE TOWN CLERK S\FF�(,�;;•_
Town of Southold �Q - Application No.,' i �'
Judith T. Terry, Town Clerk 4a " `.�►:
Residential
Town Hall, 53095 Main Road '
P. O. Box 1179 v' Non-Residential tV
Southold, New York 11971 O �O�'���`�
Telephone : f41 1
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. N/.37
Fee $ 02g-°:3 - -
DATE 1 � --)AL
OWNER NAME: 'Ur-4,r%
n
OWNER MAILING ADDRESS: R�i,r�� - �s7 SEM r., ,
J�l eW:L
islvttittick, NY 11952
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: —1
TAX MAP NO. : Section 0 Block 3 Lot
CROSS STREET: fU S
TYPE OF SYSTEM: Septic Tank ---- New Existing
Cesspool 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.)
4.u�/4
S ;nature of A. .licant
RECEIVED BY: b .1.., �y� 1e�t
octI@�iewn Cerk's Office
DATE: DEC 2 3 LI
inwn Clerk Southold
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