HomeMy WebLinkAboutGibbons OFFICE OE THE TOWN CLERK . ic,Of[Uri
Town of Southold 4 • �
Judith T. Terry, Town Clerk ,. 4
Town Hall, 53095 Main Road 'mac
P. 0. Box 1179
Southold, New York 11971 - `O .•
Telephone
--
(516)
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 302 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: JOhn W. Gibbons
OWNER MAILING ADDRESS: RR 1 , 720 Midwood Road
Cutchoque, New York 11935
OWNER PROPERTY ADDRESS: 720 Midwood Road
Cutchoque, New York
OWNER TELEPHONE ' NUMBER: 516-734-6442
TAX MAP NO. : Section 110 Block 2 Lot 19
CROSS STREET: Between Eastwood Road and Holden Avenue
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: January 20, 1987
r-4564;71
Judith T. Te y
Southold Town Clerk
DATE: May 11 , 1987
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK c31F�(,� •
Town of Southold Oho - �Q Application No. �D02_,
Judith T. Terry, Town Clerk `` '
Residential
Town Hall, 53095 Main Road �.
P. O. Box 1179 in ; 0" 0- ` ; Non-Residential
Southold, New York 11971
Telephone ' ( 1�0..
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. c a -
Fee $ 02; ��
DATE g ! /7
OWNER NAME: J9l/Aj l3&&/1.25
OWNER MAILING ADDRESS: RIP1 _ 7� i1wcoh J)
Cur- i-0c wet 1.4-V,
OWNER PROPERTY ADDRESS: Sme
OWNER TELEPHONE NUMBER: 73t,' 01/2–
,
TAX MAP NO. : Section /I0 Block Lot /9
CROSS STREET: &77 i iti 1/967 WOOD ED MO 14 ,11 /1
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ` New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: 301 mg-7
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.)
/41-4Ai/
A AkAV1/44V
Signature of Applicant
RECEIVED BY:1-1.v-x_a c—
REGI lark's O fice
DATE: MAY 1 1 1007
- bcbY
Town Clerk Southold
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