HomeMy WebLinkAboutFleet (3) OFFICE OF THE TOWN CLERK •c.OFEJi %
Town of Southold
Judith T. Terry, Town Clerk _l � ,
Town Hall, 53095 Main Road te, t,
P. O. Box 1179 cin �' �c d
Southold, New York 11971 ` �
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Telephone ' l
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 371 Residential
Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: Kathryn Fleet
OWNER MAILING ADDRESS: 350 West Creek Avenue
Cutchoque,, New York 11935
OWNER PROPERTY ADDRESS: Old Pasture Road
Cutchoque, New York
OWNER TELEPHONE NUMBER: 516-734-6095
- TAX MAP NO. : Section 103 Block 13 Lot 2
CROSS STREET: Corner of Old Pasture Road and West Creek Avenue
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
Judith T. Terry
Southold Town Clerk
DATE: July 29; 1987
(TOWN SEAL) -
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,OFFICE OF THE TOWN CLERK Y _ �V�Fd(�'
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Town, of Southold ,� cix Application No. 37/
Judith T. Terry,
Town Clerk
Town Hall, 53095 Main Road .G Residential .�
I
P. O. Box 1179 . "_ 7 '
vs Non-Residential
Southold, New York 11971 O ® ••
Telephone j Y1
(516) 765-1801
TOWN OF SOUTHOLD °
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for ----- - -
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE
OWNER NAME: 409- T/J R>'A (,1�
OWNER MAILING ADDRESS: ���� C�AKLic
and i-9 1% ``1 . t 7,16
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OWNER PROPERTY ADDRESS: it rim )19 ; 1..W2.,
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OWNER TELEPHONE NUMBER: S/' 6— ® 7.3
TAX MAP NO. : Section /63 Block / 3 Lot
CROSS STREET: ,,-ket/ ( C,pQz ke/ Gz.1.4/4"C7a�4 'x-
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing X
Residential Y\ 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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Signatu - of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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