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HomeMy WebLinkAboutParker (2) OFFICE OF THE TOWN CLERK • �OF�l'; -'").\ Town of Southold QQ� C Judith T. Terry, Town Clerk Z A, Town Hall, 53095 Main Road a P. O. Box 1179 - �� v' •' rt Southold, New York 11.971 O ` y;3 �•e•• Telephone "'°.(•f ��® (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 576 Residential x Non-Residential Fee $ 10.00 Septic Cesspool x NAME OF OWNER: William J. and Shirley A. Parker OWNER MAILING ADDRESS: 17 Edgewood Place Huntington, New York 11746 OWNER PROPERTY ADDRESS: 465 Dogwood Lane Mattituck, New York 11952 OWNER TELEPHONE NUMBER: 516-417-6482 TAX MAP NO. : Section 106 Block 8 Lot 9� CROSS STREET: Daisy Lane TYPE OF SYSTEM: Septic Tank New Existing Cesspool X New Existing x Residential X Non-Residential DATE OF PREVIOUS PUMP-OUT: 1986 Judith T. rry Southold Town Clerk DATE: January 14, 1988 • (TOWN SEAL) OFFICE OF THE TOWN CLERK 'S�FFOI,K� Town of Southold �� '. 5 - ,W. , Application No. J 7,7 Judith T. Terry, Town Clerk .ii. , Town Hall, 53095 Main Road '_ �5� Residential P. O. Box 1179 cn Lbfi z Non-Residential Southold, New York 11971 O ® •• I�• Telephone _ ( fry (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION - for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ • DATE Trh/Vi o�-, /y R OWNER NAME: /if//.C.�C.,4, / —/ - //4 /?/0-7 lT `7,j 4K OWNER MAILING ADDRESS: 44-6c)600 /jG/ //g7olit S74- 77oL! /(1//(76 OWNER PROPERTY ADDRESS: - ,f 21 C. OWNER TELEPHONE NUMBER: /-//J- 7- 6 T gr7.„ L5.Wsh-7-t©/a,a-S `a& -- TAX MAP NO. : Section Block CG -C>(> Lot 5V/(-2/LL0 al/Ye-00,5-7g CROSS STREET: Z26/.S _,4/01 TYPE OF SYSTEM: Septic Tank New Existing Cesspool New Existing Residential ,�/ Non-Residential DATE OF PREVIOUS PUMP-OUT: lr LOCATION MAP116Thst 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.) /1,--‘1,44/01-),gnature of Applicant RECEIVED BY: ///74P Town Clerk's Office DATE: ���� . 3r//ee Cg M Sn /4Z-- c(:),e69 c ssP©d �. c'/Y77dAl L) -1J