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OFFICE OF THE TOWN CLERK .c0FOU(`,O
Town of Southold 0is
• Judith T. Terry, Town Clerk A
Town Hall, 53095 Main Road
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P. O. Box 1179 ' trz
Southold, New York 11971 p r, .,0�II
Telephone ' 0.( [ $‘6
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 2.67 Residential X
Non-Residential
Fee $ 10.00 Septic Cesspool y
NAME OF OWNER: Emma Perrella
OWNER MAILING ADDRESS: North Parish Drive
Southold. New YOrk 11971
OWNER PROPERTY ADDRESS: North Parish Drive
Southold. New York
OWNER TELEPHONE NUMBER: 516-765-3591
TAX MAP NO. : Section 71 Block 1 Lot
CROSS STREET: North Bayview Road
TYPE OF SYSTEM: Septic Tank . New - Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: February 1987
004 641°1°6 *.°:44 6°84 44" •
• Judith T. Terry
Southold Town Clerk
DATE: April 13, 1987
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK UFFQi.I'=
Town of Southold �� C'® t•, Application No. c2(07
Judith T. Terry, Town Clerk ` .. Y -,
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Town Hall, 53095 Main Road - 1 Residential
P. O. Box 1179 cn Non-Residential
Southold, New York 11971
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
•
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ \b ao
DATE 3\ 9
7
OWNER NAME: ,j(r\
OWNER MAILING ADDRESS: ' 00a---c)...„ c kS\r,
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4..:1-1-‘_c$1_,,0
OWNER PROPERTY ADDRESS: Nb vzL
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OWNER TELEPHONE NUMBER: --11
TAX MAP NO. : Section "7/ Block / Lot C,"02-1
CROSS STREET: at-s-1q-c"f _
TYPE OF SYSTEM: Septic Tank / New Existing
Cesspool New Existing
Residential Non-Residential
DATE' OF PREVIOUS PUMP-OUT: V 81
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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