HomeMy WebLinkAboutGildersleeve OFFICE OF THE TOWN CLERK
Town of Southold
Judith T. Terry, Town Clerk 4 ).#4,14'?","
Hall � • �, �t�
Town , 53095 Main Road c • , a
P. O. Box 1179 cn
Southold, New York 11971 \ _ •�
Telephone ./
(516) 765-1801 1
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation- Permit No. 574 Residential x
Fee $ Non-Residential
10.00
Septic Cesspool x
NAME OF OWNER: George and Eileen Gildersleeve
OWNER MAILING ADDRESS: Box 997
Mattituck, New York 11952
OWNER PROPERTY ADDRESS: Camp Mineola Road
Mattituck, New York
OWNER TELEPHONE NUMBER: 516-298-4293
TAX MAP NO. : Section 123 Block 5 Lot 2
CROSS STREET: Kraus Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New X Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown . •
•
Judith T. Torry
Southold Town Clerk
DATE: January 11 , 1988
(TOWN SEAL)
d � _
OFFICE OF THE TOWN CLERK Ic0FOUr
Town of Southold Application lication No.
Oho � -• - QG' A
Judith T. Terry, Town Clerk . Z -
�- °4 -•C � Residential
Town Hall, 53095 Main Road ctnttll
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P. O. Box 1179 �`' Non-Residential
Southold, New York 11971 0� '? � `�
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Telephone : .(
•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT •
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /0
DATE
OWNER NAME: Geor3 e j Ci lees (;, [c/
OWNER MAILING ADDRESS: /3J) q'97
l`ia-tfL rick, ir��L
OWNER PROPERTY ADDRESS: d(,), /iq'iei/o ,(/qcI
�zf 1 fz ,lc w� Y t1
OWNER TELEPHONE NUMBER: ,,%1- 4f/j�L_...
TAX MAP NO. : Section / 623 Block S Lot 022
CROSS STREET: t" +ci,5 &
TYPE OF SYSTEM: Septic Tank New Existing
'66" -'L-46
Cesspool New Existing j/
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: e"..41'^ /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.)
(1., egi16-4 cLZW)`0
Signature of Applicant
RECEIVED BY: IA/k-.t',-
Town C rk's Off ce
DATE: REC'EBvc
AN 1 Iv
Tnwr, CL r& Southold
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