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OFFICE OF THE TOWN CLERK FO
Town of Southold , D•� � C�G
Judith T. Terry, Town Clerk J'
Town Hall, 53095 Main Road c ' . AEr
P. O. Box 1179 � �L^;_` g'
Southold, New York 11971 •
Telephone 0/ I •6 •0
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 90 Residential XX
Fee $ 10.00 Non-Residential ,
Septic Cesspool XX
NAME OF OWNER: Anne G. Sanderson (Mrs. Thomas M. Sanderson)
OWNER MAILING ADDRESS: 2730 Pine Tree Road
Cutchoque, New York 11935
OWNER PROPERTY ADDRESS: 2730 Pine Tree Road
Cutchoque, New York 11935
OWNER TELEPHONE NUMBER: 516-734-7598
TAX MAP NO. : Section 104 Block 2 Lot 15
CROSS STREET: Sterling Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool XX New Existing XX
Residential XX Non-Residential
DATE OF PREVIOUS PUMP-OUT: July 14, 1986
Judith T. Terr
Southold Town Clerk
DATE: October 15, 1986
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,(TOWN ',SEAL)
2- OFFICE OF THE TOWN CLERK �COFO(,(���.
Town of Southold ,. CSG', Application No.9
Judith T. Terry, Town Clerk '
Town Hall, 53095 Main Road " ' . : I Residential
P. O. Box 1179 y' 4- . z Non-Residential
Southold New York 11971 O ® y $
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Telephone �l ��
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
RECEIVED
_ APPLICATION
OC! ! 51986
for
Town Clerk Southold
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 9D
Fee $ 1 0. -- -
DATE October 6, 1986
OWNER NAME: Anne G. Sanderson (Mrs. Thomas M. Sanderson )
OWNER MAILING ADDRESS: 2730 Pine Tree Road
Cutchogue, New York 11935
OWNER PROPERTY ADDRESS: 2730 Pine Tree Road
Cutchogue, New York 11935
OWNER TELEPHONE NUMBER: 516-734-7598
TAX MAP NO. : Section 104• Block 2 Lot 15
CROSS STREET: Sterling Road ( dead ends at Pine Tree Road)
CESSPooL.
TYPE OF SYSTEM: Septic Tank X New Existing X
214D Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: July 14, 1986
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.)
Signatu e )f Applicant
RECEIVED BYG 4.64 v • Am"
Town / lerk's Of, ce
DATE: �► /S
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