HomeMy WebLinkAboutSouthampton Lumber OFFICE OF THE TOWN CLERK I • FU
Town of Southold �S�FC�G
Judith T. Terry, Town Clerk ; '•
Town Hall, 53095 Main Road
P. O. Box 1179 C`� . f' •
Southold, New York 11971 \�O` �O� ••
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. NR' 21 Residential
Non-Residential x
Fee $ 25.00
Septic Cesspool x
NAME OF OWNER: Southampton Lumber Corp.
OWNER MAILING ADDRESS: P.O. Box 3003
Southampton, New YOrk 11968
OWNER PROPERTY ADDRESS: Main Road
Mattituck, New York 11952
OWNER TELEPHONE NUMBER: 516-283-2000
TAX MAP NO. : Section 114 Block 11 Lot 24-3
CROSS STREET: Reeve Avenue
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool x New Existing x
Residential Non-Residential g
DATE OF PREVIOUS PUMP-OUT: Odtober 16, 1986
Judith T. Terr !F
Southold Town Clerk
DATE: October 31, 1986
(TOWN SEAL) -
fr
OFFICE OF THE TOWN CLERK cOPD(i.
Town of Southold Application No�j/R <1.2,/
Judith T. Terry, Town Clerk Y �') Residential
Town Hall, 53095 Main Road •
.-
P. O. Box 1179 cn " s;:c :' Non-Residential
Southold, New York 11971O O'r e
Telephone = j , Y►
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. ,'y,€ .2/
Fee $ '5
DATE 101Z412,[p
OWNER NAME:] SoUTI-IRMi'ToN LUMSL.i2 . 6oe.-I-•
OWNER MAILING ADDRESS: p.o. 60X 300.3 _
• 1_ SoUTI+AM PToN IJ taW (ORAL 119 Lv8
OWNER PROPERTY ADDRESS MAIN rGOA�
NfirrPi-rum tJeW Yok.g- 11952- I
OWNER TELEPHONE NUMBER: 1 253 - Zvvc
TAX MAP NO. : Section Block % I Lot 2-1-3
CROSS STREET: MA(PJ 12.0Ab
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool , New Existing
Residential Non-Residential V
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.)
Sign.ture of "pplicant .
RECEIVED BY:
Town Ierk's O fice
DATE:
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