HomeMy WebLinkAboutRind OFFICE OF THE TOWN CLERKcOTL 'C
Town of Southold �®Op .Judith T. Terry, Town Clerk ._
Town Hall, 53095 Main Road
P. 0. Box 1179 cP ;{ `{ !x` ; wig
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Southold New York 11971
Telephone ' "ZI
(516) 765-1801 �' m
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 377 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool X
NAME OF OWNER: Royston P. Rind
OWNER MAILING ADDRESS: P.O. Box 74
Mattituck, New York 11952
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OWNER PROPERTY ADDRESS: Meday Avenue
Mattituck, New York 11952
OWNER TELEPHONE NUMBER: 516-298-4989
TAX MAP NO. : Section 113 Block 9, Lot 4
CROSS STREET: Howard Avenue
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 30_, 1987
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK �c��FF�(�'�'�
Town of Southold �� CQ ' Application No.377
Judith T. Terry, Town Clerk . y
Town Hall, 53095 Main Road o Residential z---""P. O. Box 1179 cn '. ► . Non-Residential
•
Southold, New York 11971 O -*� *" �•`
Off. •'
Telephone _ .�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ 10.00
DATE lait4.13, 2. Rf ( L c97
OWNER NAME: ROYSTON P. RIND
OWNER ,MAILING ADDRESS: P.O. BOX 74, MATTITUCK, N.Y'. 11952
OWNER PROPERTY ADDRESS: MEDAY AVENUE
MATTITUCK
OWNER TELEPHONE NUMBER: (516) 298-4989
TAX MAP NO. : Section 113 Block 9 Lotqp incl.
CROSS STREET: Howard,Avenue
TYPE OF SYSTEM: Septic Tank ;E4 New Existing
Cesspool Yes New Existing Yes
Residential yes 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.)
z44..e_
rature of - pplicant
RECEIVED BY:
Town Clerk's Office
DATE:
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