HomeMy WebLinkAboutFinn OFFICE OF THE TOWN CLERK • •cOFO ,`,"
Town of Southold 0�
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road kx
P. O. Box 1179 _ - W$•
Southold, New York 11971 Q - •
Telephones
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 131 Residential x
Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: William and Judy Finn
OWNER MAILING ADDRESS: Box 337, Peconic Bay Blvd.
Laurel, New York 11948
OWNER PROPERTY ADDRESS: Peconic Bay Blvd.
Laurel, New York
OWNER TELEPHONE NUMBER: 516-298-4452
TAX MAP NO. : Section 126 Block 105 Lot 4TF /42.-
CROSS
c2.CROSS STREET: Bray Avenue
-
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool x New Existing x
Residential x Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
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Judith T. Terry,
Southold Town Clerk
DATE: November 7'; 1986
(TOWN SEAL) -
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OFFICE OF THE TOWN CLERK c,��FFpC�c
Town of Southold ��` QG' , Application No. /3/
Judith T. Terry, Town Clerk i2 ,.., y
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Town Hall, 53095 Main Road c ; � f= .?
Residential
tI7 `sc
P. O. Box 1179 � � Non-Residential
Southold, New York 11971 6�, ' •,`
Telephone _ .(
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for -
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
•
Operation Permit No. '3/
Fee $ A/0
DATE ///776A
OWNER NAME: / I7V7
OWNER MAILING ADDRESS: 60-"X 5 3 7 -/ &C e/91' J-iI2 2
OWNER PROPERTY ADDRESS: P O l-G /3 //_-t/l2
•
OWNER TELEPHONE NUMBER:
TAX MAP NO. : Section /2-6 Block 5 Lot C
CROSS STREET: / A1GG � f&/'9 '4'`✓ .
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool V 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.)
Signature of pplicant
RECEIVED BY: Ltc,—U-
Town Clirk's Office
DATE:
NOV 07 go
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