HomeMy WebLinkAboutFleet OFFICE OF THE TOWN CLERK cOFOLI(�'
Town of Southold �� `�l/
Judith T. Terry, Town Clerk ft� }
Town Hall, 53095 Main Road tow
P. O. Box 1179 ' �'
Southold, New York 11971 - ` � •
Telephone _ ®d
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 565 Residential )(
Non-Residential
Fee $ 10.00 Septic Cesspool _X
NAME OF OWNER: Evelyn S. Fleet
OWNER MAILING ADDRESS: P.O. Box 294
Cutchogue, New York 11935
OWNER PROPERTY ADDRESS: Main Road
Cutchogue, New York
OWNER TELEPHONE NUMBER: 516-734-6739
TAX MAP NO. : Section 103 Block 7 Lot 16
CROSS STREET: Depot Lane
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool x New Existing x
Residential x Non-Residential
DATE OF PREVIOUS PUMP-OUT: October 17. 1986
Judith T. Te -y
Southold Town Clerk
DATE: January 8. 1988
(TOWN SEAL)
s II III I�Qi
OFFICE OF THE TOWN CLERK ��FFO
Town of Southold �� -YG Application No. 5s,
Judith T. Terry, Town Clerk
Town Hall, 53095 Main RoadVi‘vi
Residential
P. O. Box 1179 ' Non-Residential
Southold, New York 11971 O .®y �` -lg
off
Telephone ! .(
(516) . 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for - -
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE ij / oZl� ice( E" 9
OWNER NAME: ) S o 9-Lid (V7' .
OWNER MAILING ADDRESS: P Q °j3 my a-9 f_ 74, cp ect
`--v1 • ( Ig3s —
OWNER PROPERTY ADDRESS: S ce ti a-o
OWNER TELEPHONE NUMBER: 734-_ G 717
j : /0 3 Block Lot /1 •
New Existing
I x New Existing
Non-Residential
\i
1-OUT: C I 'J i 7 6
hed hereto before permit may be issued.
ing and system; give north arrow and feet
a roximatel to buildingand closest road.)
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Sig ature of Applicant
RECEIVED BY: -
Town Clerk's Office
DATE: