HomeMy WebLinkAboutGregory OFFICE OF THE TOWN CLERK ' 'c�VFFOUr �` •
Town of Southold �� w_ �__. - `'e
Judith T. Terry, Town, Clerk 0 f _ '`^
Town Hall, 53095 Main Road •.•c
P. O. Box 1179 cn u ' `'� r77
Southold, New York 11971
Telephone -01ailit
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 7 ' Residential XXX
Non-Residential
Fee $ 10. 00
Septic XXX Cesspool
NAME OF OWNER: Norma Gregory
OWNER MAILING ADDRESS: 1180 Nnrtnn ' G Lane RFP.-13
Southold , New York 11971
OWNER PROPERTY ADDRESS: same
OWNER TELEPHONE NUMBER: 765- 5418
TAX MAP NO. : Section 63 Block 1 Lot 11 ' '
r -
CROSS STREET: Main Road (Route 25)
.• TYPE OF SYSTEM: Septic Tank New Existing
Cesspool XXX New Existing XXX .
Residential XXX Non-Residential
DATE OF- PREVIOUS PUMP-OUT: 7/1 /86
•
• Judith T. Terry
Southold Town Clerk
DATE: August 15 , 1986
(TOWN SEAL)
ii vs _
OFFICE OF THE TOWN CLERK o5�FF0(,r :`
Town of Southold �� C0�' Application No.
Judith T. Terry, Town Clerk "rem
Residential
Town Hall, 53095 Main Road :
P. O. Box 1179 cn = •`' Non-Residential
Southold, New York 11971 O
Telephone 1j
lt
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ )'b{ a t7
DATE August 13 , 1986
OWNER NAME: Norma Gregory (Ward C . )
1180
OWNER MAILING ADDRESS: Horton ' s Lane , RFD # 3
Southold, New York 11971
OWNER PROPERTY ADDRESS: same
OWNER TELEPHONE NUMBER: 765-5438
TAX MAP NO. : Section 63 Block 1 Lot 11
CROSS STREET: Main Road (Route 25)
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing XX
Residential XX Non-Residential
DATE OF PREVIOUS PUMP-OUT: July 1 , 1986
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.)
.6d
Signature of App ' ant
RECEIVED BY: 4,- .y
To, n C erk's •ffice
DATE:
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