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HomeMy WebLinkAboutRiverhead Bldg Supply OFFICE OF THE TOWN CLERK • •civ RIU(/►' Town of Southold DSO OGS Judith T. Terry, Town Clerk % � %A y Town" Hall, 5305 Main Road 'L P. O. Box 1179U' e Southold, New York 11971 Q ® €� ••, Telephone 16‘) • (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. NR&7 Residential Fee $ 10.00 Non-Residential X Septic Cesspool X NAME OF OWNER: Riverhead Building Supply OWNER MAILING ADDRESS: Route 25, Box 118 Greenport, New York 11944 OWNER PROPERTY ADDRESS: Route 25 Greenport, New York OWNER TELEPHONE NUMBER: 516-477-1906 TAX MAP NO. : Section 46 Block 1 Lot CROSS STREET: Moores Lane • TYPE OF SYSTEM: _ Septic Tank New Existing Cesspool X New Existing x Residential X Non-Residential DATE OF PREVIOUS PUMP-OUT: -May 1987 + Judith T. Terry Southold Town Clerk - DATE: July 14, 1987 (TOWN SEAL) " OFFICE OF THE TOWN CLERK c3\\VMA' -- Town of Southold A CQG Application No:///k\,3 7 Judith T. Terry, Town Clerk Town Hall, 53095 Main Road cvK7.7 " }{; : Residential P. O. Box 1179 Lin Non-Residential Southold, New York 11971 O ®Tr s `� •` #51f6:1- y 4____ Off-••• Telephone =Jo1 (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICAT ION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ ,R5"'?' DATE 7_ /474_ OWNER NAME: �I (�_ OWNER MAILING ADDRESS: OWNER PROPERTY ADDRESS: . OWNER TELEPHONE NUMBER: ,5-7‘ — L/ 7 7_ / 517 TAX MAP N Section p' 9( , v 0 Block ar/, a o Lot o /, COO CROSS STREET: o�-�[ -Q • TYPE OF SYSTEM: Septic Tank New Existing Cesspool fid New Existing fig Residential Non-Residential DATE OF PREVIOUS PUMP-OUT: C � ?va �� - l' 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: • - ,. r,,7i' , '- - •,'.7f;...2,-, It., y♦i .: -@T+•y"p r,".".•;,''''`.'";-`'•-:x'•.••.'i, '',�, ''''t:,'•„!1.;,jl;L - %t' _4'a''' `'• 1 1, - - ''rl>,1.. tt� ((.. 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