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JUDITH T. TERRY ;, : Town Hall, 53095 Main Road
TOWN CLERK G T P.O. Box 1179
REGISTRAR OF VITAL STATISTICS � Southold, New York 11971
MARRIAGE OFFICER yQ O�' '�, Fax (516) 765-1823
�1D �� Fax
(516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3138-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner PALEY, NORMAN T.
Mailing Address 1 P. O. BOX 187
Mailing Address 2
City St Zip LAUREL NY 11948-0000
Property Address 1 1525 ALDRICH LANE
Property Address 2
City St Zip LAUREL NY 11948-0000
Owner Telephone No. 516-298-4056
Tax Map No. section 125.00 block 2 lot 1 .011
Cross Street MAIN ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 10/26/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK .c3\\VFULA' &/2Y
/2 (i
Town of Southold � CQ Application No. / ll
Judith T. Terry, Town Clerk � � �►
Town Hall, 53095 Main Road ;: $10.00 - Residential
P. O. Box 1179 $25.00 - Non-Residential
Southold, New York 11971 O ® ��`,
Telephone �j *".°1
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ f0
J
DATE -4 /cJ.- /c7c '3
OWNER NAME: Noii-i ) -77 ,0/4(
OWNER MAILING ADDRESS: e.c, B( c
OWNER PROPERTY ADDRESS: 1,crcq(r Pr Ur) c
OWNER TELEPHONE NUMBER: @7 ) 1. Or— +9 jt
TAX MAP NO. : Section ( OS Block 2- Lot 1, I
CROSS STREET: ,j X) A %•-' I E L ��
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: r)-11)4-hfe--- ( Z?
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.)
t iz4 e�%t//
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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TERRY WOODHULL a LAURA WOODHULL A , 1980
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AT LAUREL DATE' DEC. 5, /979
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T. If1tt. : for tt;l: loc+,t►.,n r.ve trim SUFFOLK COUNTY, NEW YORK NO. 79.646
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