HomeMy WebLinkAboutRobins OFFICE OF THE TOWN CLERK I c31Fafro) •
Town of Southold afro),
Judith T. Terry, Town Clerk � t::1:
Town Hall, 53095 Main Road k
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P. O. Box 1179 x }
Southold, New York 11971 Q ��0�- �',
Telephone y _ i
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 161 Residential x
Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: Bernard Robins & Wife
OWNER MAILING ADDRESS: 1550 Strohson Road
Cutchoque, New York 11935
OWNER PROPERTY ADDRESS: 1550 Strohson Road
Cutchoque, NY 11935
OWNER TELEPHONE NUMBER: 516-734-6381
TAX MAP NO. : Section 103 Block 10- Lot 30.1
CROSS STREET:, Baldwin Place
TYPE OF SYS1EM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: 1981
•
Judith T. Terry
Southold Town Clerk
DATE: December 1 , 1986
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(TOWN SEAL)
OFFICE OF THE TOWN CLERK �FFO
Town of Southold ��� CQ Application No. A/
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road ' •r" Residential
A z; r �,
P. O. Box 1179 � �i � Non-Residential
Southold, New -York 11971 ��0�,��
Telephone
414(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. /6 /
Fee $ /0 °s
DATE AM// 1 fe.4
OWNER NAME: /.10-41/4-4,/2 „ted6i - y hir,C
OWNER MAILING ADDRESS: J c,5 0 5je0/J5d/U ,CO
OWNER PROPERTY ADDRESS: ,/ c o 67 (//4.50,..,k6
OWNER TELEPHONE NUMBER: `7 y- 63 kJ
TAX MAP NO. : Section 1O3 Block /0-3C9 Lot 3 0
CROSS STREET: 6-7-kU/3-SdAAF
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing )<'
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: / geF/
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 Applicant
RECEIVED BY: O 6(
Town Jerk's O fice
DATE:
DLQ 01 mg
Town Clerk Southold
.The
S 12ORS00 ROA 10
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