HomeMy WebLinkAboutRobinson (3) OFFICE OF THE TOWN CLERK • .c)IFO(k�►�
Town of Southold
Judith T. Terry, Town Clerk � Z TM., f }`
Town Hall, 53095 Main Road o _ .
P. O. Box 1179 v' _
Southold, New York 11971 ` O` "O"
Telephone2i
(516) 765-1801 •
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 615 Residential x
Non-Residential
Fee $ 10.00
- - Septic Cesspool x
NAME OF OWNER: Mrs. Arnold Robinson (Jean Robinson)
OWNER MAILING ADDRESS: RR 1, 9905 Nassau Point Road
Cutchoque, _New York 11935
OWNER PROPERTY ADDRESS: 9905 Nassau Point Road
Cutchogue, New York
OWNER TELEPHONE NUMBER: 516-734-6753
TAX MAP NO. : Section 119 Block 1 Lot 7
CROSS STREET: Bridge Lane
- TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
•
• Judith T. Tdfry -
Southold Town Clerk
DATE: February 22, 1988 - .
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- - (TOWN SEAL)
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OFFICE OF THE TOWN CLERK �c�VFFO(�.„ /�
Town of Southold CQG Application No.
Judith T. Terry, Town Clerk
;
.4�cu � � Residential
Town Hall, 53095 Main Road -; t ;t
P. O. Box 1179 � r ; Non-Residential
Southold, New York 11971 O`� •
y,���`
Telephone _ .( *
•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL '
Operation Permit No. 15--
•
$ /O ��
Fee
DATE
OWNER NAME: , AVYI2-1 JCb bI`n ;Q7.4
OWNER MAILING ADDRESS: fl iZ . B, C1 qos' /y,ocgaa prc
tit-c-11og�� ` y I <�T35-
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: 73 Lf. - 7S.
TAX MAP NO. : Section /(9 Block ) Lot 7
CROSS STREET: 1.),., ," l „ -�,
y TYPE OF SYSTEM: Septic Tank New Existing
v1 Cesspool New Existing �-
Residential ' Non-Residential
DATE OF PREVIOUS PUMP-OUT:
lA' LOCATION MAP: Must be attached hereto before permit may be issued.
'J (Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
N
6 6 vpiccni
Signature of Applicant
RECEIVED BY:01P
Town ' lerk's Of ice
DATE: Oi7