Loading...
HomeMy WebLinkAboutRichmond • OFFICE OF THE TOWN CLERK • cOf© Town of Southold , ,� G,, Judith T. Terry, Town Clerk _ >, Town Hall, 53095 Main Road P. O. Box 1179 Southold, New York 11971 v® S . tee- Telephone - *qtr' (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 372 Residential X Non-Residential Fee $ 10.00 ` Septic Cesspool x NAME OF OWNER: Robert W. and Helen R. Richmond OWNER MAILING ADDRESS: 33900 Main Road Cutchogue, New York 11935 OWNER PROPERTY ADDRESS: 33900 Main Road' Cutchogue, New York 11935 OWNER TELEPHONE NUMBER: 516-734-0805 • TAX MAP NO. : Section 97 Block 2 Lot 11 CROSS STREET: Eugenes 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. Terry Southold Town Clerk DATE: July 29, 1987 (TOWN SEAL) -- OFFICE OF THE TOWN CLERK �FFD Town of Southold �o� . - �QG', Application No —' Judith T. Terry, Town Clerk Town Hall, 53095 Main Road -' Residential P. O. Box 1179 cn 4 t7,461 �i � Non-Residential Southold, New York 11971 ® '® 'Ire$ Telephone (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICAT ION for OPERATION PERMIT SEPTIC TANK or CESSPOOL ,Operation Permit No. • Fee $ DATE 2//3 / r OWNER NAME: D t6q 1 Jul] e t2 &Imo-Aka OWNER MAILING ADDRESS: 3 j.& &Am/ ieeyi.p e,LCTC,I)--O 6 11/ -c9 . / 17s,5 A' I2 OWNER PROPERTY ADDRESS: S.( JAI F_ 7)- 5 6P U r OWNER TELEPHONE NUMBER: PI `��39 — 6,80J— TAX 565TAX MAP NO. : Section 5 11 Block ,7 Lot CROSS STREET: y1eciN,p5t- )144 '- .0-- r" ceite.,S t Cod( L&ii e TYPE OF SYSTEM: Septic Tank 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.) .L .it.. Signature of Applicant RECEIVED BY: Town Clerk's Office DATE: -t / TH 719 /1-01/1/ fin 0 Cfte ,- I (.3`-,