HomeMy WebLinkAboutFleet (2) OFFICE OF THE TOWN CLERK O
Town of Southold \ y
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road
P. O. Box 1179 ,` • - �
Southold, New York 11971 \••,•.0*,
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Telephone = �( t
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 175 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool x
NAME OF OWNER: Evelyn S. Fleet (Mrs. Clarence)
OWNER MAILING ADDRESS: P.O. Box 294
Cutchoque, New York 11935
OWNER PROPERTY ADDRESS: Main Road
Cutchoque, New YOrk
OWNER TELEPHONE NUMBER: 516-734-6739
TAX MAP NO. : Section 102 Block 6 Lot 23.1
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: 1979
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Judith T. Ter
Southold Town Clerk
DAT-E: December 11 , 1986
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK � OH(,�. �
Town of Southold �� , BOG'_, Application No. /7'
Judith T. Terry, Town Clerk ,
�.. -; '4; ..<t %) Residential 1�
Town Hall, 53095 Main Road . { -
P. O. Box 1179 ` . z Non-Residential
Southold, New York 11971 ‘t1),-
;may,, �O1
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Telephone : .I J ,
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. /'
Fee $
DATE LQ - - -i '7 �r
OWNER NAME: C1ti42-e 4e_) s % er (7.i
CGL�c -
OWNER MAILING ADDRESS: (J ,6412 ci -
71, 'et . ( ( ? 36—
OWNER PROPERTY ADDRESS: � � CL-.1 ��.�•.4
OWNER TELEPHONE NUMBER: �` %�, 'T 3 4- Cc 13
TAX MAP NO. : Section /U a- ' Block -6 2. 3,.' Lot /
CROSS STREET: ���� 2/4--h'
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing >4.,
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: 79
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.)
S . 9 -camLi--
Sig ture of Applicant
RECEIVED BY: 6iµ
����� o,.0 perkrs ffice
DATE: i 1111@As
Toru' Cut South®ld