HomeMy WebLinkAboutGwydir OFFICE OF THE TOWN CLERK - • icORIU{`+-
Town of Southold %
Judith T. Terry, Town Clerk ; �
Town Hall, 53095 Main Road o , #,
P. O. Box 1179 =` `
Southold, New York 11971 O��!
Telephonel ��
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
• SEPTIC TANK or CESSPOOL
Operation Permit No. 485 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool X_
NAME OF OWNER: Richard and Judith Gwydir
OWNER MAILING ADDRESS: Box 90 G, Vanston Road
Cutchoque, New York 11935
OWNER PROPERTY ADDRESS: Vanston Road
Cutchogue, New YOrk
OWNER TELEPHONE NUMBER: 516-734-6287
TAX MAP NO. : Section 111 Block 4 Lot 7
•
CROSS STREET: Wunnewetta Road and Haywaters Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
•
tli rry
Southold To n Clerk
DATE:- November 17, 1987
(TOWN SEAL)
OFFICE OF THE TOWN CLERK CiffU'fli
Town of Southold moo . Application No. W5—
Judith T. Terry, Town Clerk ': y
Town Hall, 53095 Main Road c ; 1 :r Residential
P. O. Box 1179 cry ' .. �' Non-Residential
Southold, New York 11971 O ® o ',`
Telephone : 1
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. ec-
Fee $ V
DATE ///371�
OWNER NAME: 0e/dia.,d �✓6G 1,/ [,t-tete,
OWNER MAILING ADDRESS: .13p,{' 9e) 6- thfrnsT®i7 ,
G`a ?..e, /U. /774 s--
OWNER
OWNER PROPERTY ADDRESS: j 1?/ ,-Te/f jed ,
e yu e
OWNER TELEPHONE NUMBER: 7.34" - oz- 17
•
TAX MAP NO. : Section /// Block Lot
CROSS STREET: 6(14e ArMetee /al. Wav&Jarets
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential l/ 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.)
,/2„6:a a 4 P
Signature of Applican
RECEIVED BY:
REcnvErvn rk's O ice
DATE: N®V1719;
Town Clerk Southold
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