HomeMy WebLinkAboutGlover OFFICE OF THE TOWN CLERK • • OFO(K`,"
Town of Southold
Judith•T. Terry, Town Clerk ; -a` J'
Town Hall, 53095 Main Road
P. 0. Box 1179
Southold, New York 11971 ^Q -- •�
Telephone 1a
116
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
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Operation Permit No. 258 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool x
NAME OF OWNER: Leander Glover Jr.
OWNER MAILING ,ADDRESS: Cox Lane
Cutchogue, New York 11935
OWNER PROPERTY ADDRESS: Cox Lane
Cutchoque, New YOrk
OWNER TELEPHONE NUMBER: 516-734-5252
TAX MAP NO. : Section 97 Block 5 Lot 2.2
CROSS STREET: Main Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
Judith T. Terr
Southold Town Clerk
DATE: April 7, 1987
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(TOWN SEAL)
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OFFICE OF THE TOWN CLERK �c�VFFOC -
Town of Southold , Application No.,_ 2(
Judith T. Terry, Town Clerk A : _
i 1 Residential
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Town Hall, 53095 Main Road � � , -
P. O. Box 1179 cr9 o ' Non-Residential
Southold, New York 11971 O '0 `•'„'`c c- 0
Telephone Ol y►�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
-- ---- for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No./
Fee $ )Q
DATE•
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OWNER NAME: keQ-0...
OWNER MAILING ADDRESS: ecr"b c'LPi.
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OWNER PROPERTY ADDRESS: Co yc L A,U-
OWNER TELEPHONE NUMBER: 73
TAX MAP NO. : Section 1 Block Lot
CROSS STREET: • c7)16.4„,;_,
IJ
TYPE OF SYSTEM: Septic Tank v. New Existing
Cesspool New Existing
-- Residential ./ Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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 App. rcant
RECEIVED BY: C -Kaa- --
Town clerk's Office
RECEIVED
DATE: t 03 7987
Town Clerk-Southold •
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