HomeMy WebLinkAboutField (2) OFFICE OF THE TOWN CLERK • F�
Town of Southold s , • ��COIj
Judith T. Terry, Town Clerk ' � - <�
Town Hall, 53095 Main Road r
P. O. Box 1179
Southold, New York 11971 ;QL' �O ,�•
Telephone : �llye
(516) 765-1801 ''-
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
' SEPTIC TANK or CESSPOOL
Operation Permit No. 250 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool x
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NAME OF OWNER: Ruth Ash Field
OWNER MAILING ADDRESS: 400 East Legion Avenue
Mattituck, New York 11952
OWNER PROPERTY ADDRESS: 400 East Legion Avenue
Mattituck, New York
OWNER TELEPHONE NUMBER: 516-298-8859
TAX MAP NO. : Section 143 Block 4 Lot 8
CROSS STREET: Bay Avenue
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: December 1986
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Judi
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OFFICE OF THE TOWN CLERK FO = '
Town of Southold COFCQG';, Application No. 015D
Judith T. Terry, Town Clerk a ��
Town Hall, 53095 Main Road Residential
P. 0. Box 1179 u' i �' Non-Residential
Southold, New York 11971
Telephone -_1°1
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.c25-U
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Fee $ it,°. 9
DATE ` _'
OWNER NAME: + Ft `e-
OWNER MAILING ADDRESS: gr 1 . �ecyon Oil
OWNER PROPERTY ADDRESS:_.__. 0. \rf‘,
OWNER TELEPHONE NUMBER:
TAX MAP NO. : Section Block Lot
CROSS STREET: u �a
TYPE OF SYSTEM: ��
Tank Septic 2
p V 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.)
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Signature of Applicant
RECEIVED BY: C om— 4
REC IVEDTown Cl k's Offiie
DATE: MJR301987
Town CMk Southold
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