HomeMy WebLinkAboutRobinson OFFICE OF THE TOWN CLERK • c5\ OU(`OG
Town of Southold f .•,�,
Judith T. Terry, Town Clerk �� :
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Town Hall, 53095 Main Road o * ,
P. O. Box 1179 � "
Southold, New York 11971 ti_p `® 'TM"' �•�
Telephone _ �l l�0��
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 338 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool X
NAME OF OWNER: Donald A. Robinson
OWNER MAILING ADDRESS: 920 Naugles Drive.
Matttiuck, New York 11952
OWNER PROPERTY ADDRESS: 920 Naugles Drive
Mattituck, New York 11952
OWNER TELEPHONE NUMBER: 516-298-8745
TAX MAP NO. : Section 99 Block 5 Lot 13
CROSS STREET: Breakwater 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 15,, 1987
(TOWN SEAL) .
OFFICE OF THE TOWN CLERK •-CO Fair
" Town of Southold CQG' . Application No. 3
Judith T. Terry, Town Clerk gl.e-44 x : �
Town Hall, 53095 Main Road c :NA)
* Residential
P. O. Box 1179 .fl re.A
' -' �:' Non-Residential
Southold, New York 11971 't:%5 e•'
Telephone i •
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ ('O- c
DATE "VII -1
OWNER NAME: (D0Pk`- • 2(1- ‘4.3
OWNER MAILING ADDRESS: Q 2O AvC'1.&=.S
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OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: 2-aq - (Z.-14Y
( 000 - c-D`Z`l -
TAX MAP NO. : Section Block Lot
CROSS STREET: 1- __ tt.�
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential ( Non-Residential
DATE OF PREVIOUS PUMP-OUT: 0%,31,4./...)0..43,3
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:
Town Clerk's Office
DATE:
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G AeANTEEJ TO T!-1E SECu i'/ TITLE Ii,Nb 6L3Ak'ANN COMPAN1
VI G NE S AND To THE NORTH F t,Fj BANK AN) Ttet)ST CiMPAN'/
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