HomeMy WebLinkAboutFolts OFFICE OF THE TOWN CLERKO `�FFU(K`;
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Town of Southold OG
Judith T. Terry, Town Clerk 1`
Town Hall, 53095 Main Road = ,
P. O. Box 1179 v'
Southold, New York 11971 .&`c-/
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Telephone = 1 Jig It'g.
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 55 Residential XX
Non-Residential
Fee $ 10.00
Septic Cesspool XX
NAME OF OWNER: Milton W. Folts
OWNER MAILING ADDRESS: RR 1 , Box 90
Cutchogue, New York 11935
OWNER PROPERTY-ADDRESS: - -90 -Oak Street
Cutchogue, New York
OWNER TELEPHONE NUMBER: 516-734-6698
TAX MAP NO. : Section 136 Block 1 Lot 54
CROSS STREET: Harbor Lane
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool XX New Existing XX
Residential XX Non-Residential
DATE OF PREVIOUS PUMP-OUT: Harbor Lane
Judith T. Terr
Southold Town Clerk
DATE: September 22, 1986
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK S�FFO�
Town of Southold �� -f CSG': Application No.
Judith T. Terry, Town Clerk y�r til Residential
Town Hall, 53095 Main Road c to ,
P. O. Box 1179 � Non-Residential
Southold, New York 11971 O*® •
Telephone Y► 16
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
II
Operation Permit No. 31-‹
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Fee $/0, '> O
DATE
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OWNER NAME: A/ / a lj/ CL) Fc
OWNER MAILING ADDRESS: 1 / )4.o p 70
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OWNER PROPERTY ADDRESS: , C) 'O >4 K' S -jpL, C 7-
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OWNER TELEPHONE NUMBER: 57(0. 75 6 6 �IS
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TAX MAP NO. : Section / 3 c Block / Lot
CROSS STREET: y-/-41,e6 A �Lfj
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ✓ New I Existing
Residential V Non-Residential
DATE OF PREVIOUS PUMP-OUT: IV/3 /9V
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 Applicant
RECEIVED BY: -6&-
Town lerk's Office
DATE:
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