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OFFICE ,OF THE TOWN CLERK • 'cgfIl(/1(`+OG _
Town of Southold , _ � .
Judith T. Terry, Town Clerk •
Town Hall, -53095 Main Road ;0 ,. ,i
P. O. Box 1179ri
Southold, New York 11971 Q "® ' ° �- •�
Telephone Ol
(516)' 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
, OPERATION PERMIT
- SEPTIC TANK or CESSPOOL
Operation Permit Na. 327 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool x
NAME OF OWNER: Louis A. and Celina- Roccs
OWNER MAILING ADDRESS: P.O. Box 1219
Mattituck, New York 11952
OWNER PROPERTY ADDRESS: 3460 Camp Mineola Road
Mattituck, New York 11952
OWNER TELEPHONE NUMBER: 516-298-8824
TAX MAP NO. : - Section 123 Block 5 Lot 12
• CROSS STREET: Reeve Avenue
TYPE OF SYSTEM: Septic Tank New • Existing
Cesspool X New Existing x
Residential X - - Non-Residential
DATE OF PREVIOUS PUMP-OUT: - Summer of 1985
Judith T. Terry - -
Southold Town Clerk
DATE.: . July 14, 1987
(TOWN.SEAL) '
OFFICE OF THE TOWN CLERK c��FFU -
Town of Southold ��� � ., Q!/ Application No. �a
Judith T. Terry, Town Clerk , t A
Town Hall, 53095 Main Road :AY '�1�=' :'� Residential
P. O. Box 1179 �' V �, Non-Residential
Southold, New York 11971 O "� �$
App -.; �Z /
Telephone = 1 • I
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee s D'
DATE 9-X-447 / �i gc97
OWNER NAME: 0 O /S �1 . ted- CYE L i1°A /fa C FS
OWNER MAILING ADDRESS: �• G /v O / A / 7
HA Tit rock, Ivy , i s`p�-
OWNER PROPERTY ADDRESS: 43 6 O ( /1H P l �NEol- H fro /5-
PA--7- 7/ rued IL . 1(. 1 , 9 \r )--
OWNER
, 9 r —OWNER TELEPHONE NUMBER: ( VC ) - (74
TAX MAP NO. : Section / Block Lot 12
—
CROSS STREET: /-1 E E V e g V T
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ,/ New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: S UM ME K l 1&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.)
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Signature of Applicant
RECEIVED BY Add41
Town lerk s Oar ice
DATE:
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