HomeMy WebLinkAboutSeaman OFFICE OF THE TOWN CLERK- • •c3IFQj/I(`,"�G
Town of Southold Q
Judith T. Terry," Town Clerk
Town Hall, 53095 -Main Road
P. 0. Box 1179 ,. ‘tr1 t "� .`
Southold, New York 11971 Qj®�- O�-�••
Telephone '0( g[
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT '
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SEPTIC TANK or CESSPOOL
Operation Permit No. 323 Residential X
Non-Residential
Fee $ 10.00
1 Septic Cesspool x
NAME OF OWNER: Lester Seaman
OWNER MAILING ADDRESS: P.O. Box 705
Cutchogue, New York 11935
OWNER PROPERTY ADDRESS: 2840' Beebe Drive
Cutchoque, New York 11935
OWNER TELEPHONE NUMBER: 516-734-5028
TAX MAP NO. :- Section 103 Block 3 - Lot 16
CROSS STREET: Wilson Road
TYPE OF SYSTEM:, Septic Tank New Existing
Cesspool X New Existing X
Residential X , Non-Residential
DATE OF PREVIOUS PUMP-OUT: March 10, 1987 - Only Pumpout
Judith T. Terry -
Southold Town Clerk •
DATE: July 14, 1987 -
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(TOWN _SEAL) -
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OFFICE OF THE TOWN CLERK cl\FFair - a
Town of Southold �� CQ Application No.CJo2_j
Judith T. Terry, Town Clerk
a� :• Residential
Town Hall, 53095 Main Road a, ;. -
P. O. Box 1179 u-3A Non-Residential
Southold, New York 11971O ® ,� ®����,`
Telephone ( , �
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE 7/3/4-7
OWNER NAME: Le/eye 5e4-/Z4AJ
OWNER MAILING ADDRESS: Q, /3v 7a
C AA Y. �/(93�s-
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OWNER PROPERTY ADDRESS: .gge, /3_ e e 7)/
OWNER TELEPHONE NUMBER: 7 3 $
TAX MAP NO. : Section /.0 3 Block 3 Lot l4
CROSS STREET: ‘L/(G 5 45,4) /?'
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool 1/ New Existing ✓
Residential 1/ Non-Residential
DATE OF PREVIOUS PUMP-OUT: � 1D 7 ® dAIL ?v0`1,0° Ov7--
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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