HomeMy WebLinkAboutFoster (2) / :-______;..
OFFICE OF THE TOWN CLERK ' �COMA' -
Town of Southold \ ; -• , CD
Judith T. Terry '
Town Clerk � t4 . 1
Town Hall, 53095 Main Road �,.: �r. , <
P. O. Box 1179 1 cr3 ZI} Wil "M ,
Southold, New York 11971
Telephone ="�1 J`44 N '
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 8 Residential XXX
'Fee ee $ _ 10. 00 -
Septic Cesspool XXX
NAME OF OWNER: Roderick W. Foster
OWNER MAILING ADDRESS: Rt 2 Laurel Avenue
a.
Southold , New York 11971 -7.
OWNER PROPERTY ADDRESS: same
5
OWNER TELEPHONE NUMBER: 765-3359
TAX MAP NO. : Section 056 Block 3 Lot 4
CROSS STREET: Main Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool XXX New Existing XXX
Residential XXX Non-Residential
DATE OF PREVIOUS PUMP-OUT: 1955
•
aedhrof-e-; g idTth T. Terry
Ju
Th
Southold Town Clerk
DATE: August 15 . 1986
(TOWN SEAL)
OFFICE OF THE TOWN CLERK �_� Cc��FFfitA-e,G
Town of Southold 0QApplication No.
Judith T. Terry, Town Clerk . <�1 Residential
Town Hall, 53095 Main Road o
P. O. Box 1179 v' r. ?c ' .` Non-Residential
Southold, New York 11971 ‘15,3 ca; 0� 0.�`
Telephone _ •
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
•
Operation Permit No.
Fee $ /�j,. t
DATE OLX?
OWNER NAME: eCAD (2_,k
OWNER MAILING ADDRESS: a UkEtn (E.
50 0010/-b
OWNER PROPERTY ADDRESS: 5q01
OWNER TELEPHONE NUMBER: 5/ X65 35 (;?
TAX MAP NO. : Section '0
Block S Lot 'p
P�
CROSS STREET: 1--AD E) AVE E / 71c / c) �cJ
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Xf Non-Residential
DATE OF PREVIOUS PUMP-OUT: j9 .5 -
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.) -
4r- \\. ( biA/(1
��\ ry �J rte" � �1 ` C:1'G�Z" ��✓
� Signature of Applicant
4
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RECEIVED BY: "404. �)
To n 'lerk' Office
DATE: R// y ��