HomeMy WebLinkAboutParker OFFICE OF THE TOWN CLERK t-\‘7FTown of Southold
Judith T. Terry, Town Clerk ,,� r
Town Hall, 53095 Main Road a
P. O. Box 1179 � � r>r�n 1.47:1_
Southold, New York 11971 ` `D�, ` +-`
Telephone _ � 0( ;� �
(516) 765-1801 lin
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 583 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: Ira A. Parker
OWNER MAILING ADDRESS: 195 Oak Drive
Cutchogue. New York 1193s
OWNER PROPERTY ADDRESS: 195 Oak Drive
Cutchogue. New York
OWNER TELEPHONE NUMBER: 516-734-6778
TAX MAP NO. : Section 104 Block 5 Lot 16
CROSS STREET: Haywaters Drive
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool x New Existing X
Residential x Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
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Ju.i ,h.,. . Yy
Southold Town- Clerk
DATE: January 26, 1988
(TOWN SEAL)
OFFICE OF THE TOWN CLERK c$FD(,r
Town of Southold CQIj•_ Application No. —
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road o ` '4 1 Residential
P. O. Box 1179O � i �. Non-Residential
Southold, New York 11971 ®.
Telephone '44:11‘f19
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for - -
OPERATION .PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
nO
Fee $ ("O
DATE rill /
OWNER NAME: A A Pte't R k E
OWNER MAILING ADDRESS: CV da ige p13-1 E t Y
OWNER PROPERTY ADDRESS: it4 }�
OWNER TELEPHONE NUMBER: 73 -Co 7 7
TAX MAP NO. : Section 16V Block Lot /A'
CROSS STREET: )4 te, /75-
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool s New Existing V
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: 3 1"2 ct7
t
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.)
bkl-A. 62- (enASte,
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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