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`OFFICE OF THE TOWN CLERK $ c3IFU[/((`,"
Town of Southold �� ,'•�; ��
Judith T. Terry, Town Clerk ti } ,k;,
Town Hall, 53095 Main Road ��'' 'c
P. O. Box 1179 ,� ' = r,;;" $$
Southold, New York 11971 Off` '" ��-�.`
Telephone �� i
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(516) 765-1801 •
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 315 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool X
NAME •OF OWNER: Martin H. and Janet Carrell
OWNER MAILING ADDRESS: 20505 Main Road
Mattituck, New York 11952
OWNER PROPERTY ADDRESS: 20505 Main Road
Mattituck, New York
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OWNER TELEPHONE NUMBER: 516-298-5095
TAX MAP NO. : Section 108 Block 3 Lot;S_7
CROSS STREET: Locust Avenue
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: December 10, 1986
tOrl-<de";gef....".
Judith T. Terry
Southold Town Clerk
DATE: June 23, 1987
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK c3�FFO(,� -
Town of Southold � . f + Cl/ , Application No. 3/51
Judith T. Terry, Town Clerk 4.14
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• Town Hall 53095 Main Road Residential
P. O. Box 1179 `. ;' Non-Residential
Southold, New York 11971 O ry .``
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
RECEIVED SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APR ® 91987
APPLICATION
Town Clerk Southold
- -- for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /D"
DATE 4f^
OWNER NAME: QPe-dee7 mwy-,
OWNER MAILING ADDRES : '2oror N1a , Ra cal
/1/1p. h lv c 1I 9 iS'
OWNER PROPERTY ADDRESS: Sa„ve
OWNER TELEPHONE NUMBER: 29 6S'O f
a f
TAX MAP NO. : Section ? Block Lot
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111
CROSS STREET: LCOCNAt .. utAw.e at Magi /?d4d
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ,?C New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: /0 /487
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.)
1.144.0 — .4ret/140,a
Signature f Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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