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OFFICE OF THE TOWN CLERK • °c4��FOI,lr
Town of Southold c•
Judith
Judith T. Terry, Town Clerk :
Town Hall 53095 Main Road
P. O. Box 1179
Southold, New York 11971 A0�
Telephone Q( 'No
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. NR 27 Residential
Non-Residential x
Fee $ 25.00
Septic Cesspool X_
NAME OF OWNER: David Strong - Strong's Marina
OWNER MAILING ADDRESS: P.O. Box 1033
Mattituck, New York 11952
OWNER PROPERTY ADDRESS: Camp Mineola Road
Mattituck, New York 11952
OWNER TELEPHONE NUMBER: 516-298-4770
TAX MAP NO. : Section 122 Block g Lot 6.2
CROSS STREET: Alois Lane
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential Non-Residential X
DATE OF PREVIOUS PUMP-OUT: Never done
•
Judith T. Terry
Southold Town Clerk
DATE: December 1 , 1986
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(TOWN SEAL)
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OFFICE OF THE TOWN CLERK `���F[J,l�. ,--
Town of Southold DSC CDG',r Application No. /1/2e.27
Judith T. Terry, Town Clerk e. w," ^h� � Residential
Town Hall, 53095 Main Road c
P. O. Box 1179 � ® � ';` ? :' Non-Residential kV-
Southold, New York 11971
Telephone? ' ' "
s.
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. /1/,e.)-7
Fee $
DATE lfde-
OWNER NAME: AL,„,;/ S--oge, 'S' H,fl'9VP,Y.�
P 113
OWNER MAILING ADDRESS: Cep Nii-Jioat ,1 i AC) 33
ritd Ar4Y
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER:
TAX MAP NO. : Section /. ?c2 Block 9 Lot 2
CROSS STREET: brw6,
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool f New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: /ifw - iy
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: -aa -
Townrk's •�fice
7-MEWED
DATE:
DOC 01 MG
Town Ghees Southold
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