HomeMy WebLinkAboutGlover (2) Ill'
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• - Town Hall, 53095 Main Road
r " jj> P.O. Box 1179
_® a, ���!� Southold, New York 11971
JUDITH T.TERRY ®1 0 -.0 TELEPHONE
' (516)765-1801
TOWN CLERK
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 852-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner GLOVER, LEANDER JR.
Mailing Address 1 815 COX LANE
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 815 COX LANE
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-5252
Tax Map No. section 97. 00 block 5 lot 1.000
Cross Street MAIN ROAD
Date Of Last Pump Out 0/00/00
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Issue Date: 9/21/88 Judith T. Te y
Southold Town Clerk
(TOWN SEAL)
OFFICE OF.THE TOWN CLERK
Town of Southold ����� �"�C ' - Application No. �5
Olj -
Judith T Terry, Town Clerk . °. y
Town Hall, 53095 Main Road s Residential
P: O. Box 1179 v' ;A, M��r ��' Non-Residential
Southold, New York 11971 O= ® "1 ;' NS
Telephone j $ i'
(516) 765-1801 t
TOWN OF SOUTHOLD
•
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE f" ,/drr
OWNER NAME: X G2-4
OWNER MAILING ADDRESS: Th5- ed2o
c."7 :(71.i frt7 /1 3 )--
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: 2.'V
TAX MAP NO. : Section Q7 Block `j Lot / .t
CROSS STREET: `'Yn ;,,- Rd-
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ✓ New Existing
Residential r/ 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 Appy,.4ft
RECEIVED BY: -
Town Clerk's Office
DATE:
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