HomeMy WebLinkAboutPetters OFFICE OF THE TOWN CLERK ��FO(f�C� •
Town of Southold
Judith T. Terry, Town Clerk A - r <�
Town n Hall, 53095 Main Road c 1°,; ., ,G
P. O. Box 1179 ' cn 41:4MIT
Southold, New York 11971 ,"\• %/1",
Telephone 911
(516) 765-1801
TOWN OF SOUTHOLD .
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 551 Residential y
Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: Franklin R. Petters
OWNER MAILING ADDRESS: 1555 Westphalia Road
Mattituck, New York 11952
OWNER PROPERTY ADDRESS: Horton Avenue
Mattituck. New York 11952
OWNER TELEPHONE NUMBER: Not isted
TAX. MAP NO. : Section 141 Block 1 Lot 9
CROSS STREET: Westphalia Road -
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: January 1987
dreofew:57:00,7:00
Judi& T.4 T y
Southold Town Clerk
DATE: December 28. 1987
' (TOWN SEAL)
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OFFICE OF THE TOWN CLERK 1,1
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Town of Southold moo, , Application No.
Judith T. Terry, Town Clerk �,
Town Hall, 53095 Main Road o ". : Residential
P. O. Box 1179 u' t'• P - ► 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. .5-51
Fee $ /0 -
DATE lik /917
OWNER NAME: ;PIA L./ /V At • 4-
OWNER MAILING ADDRESS: `.553 (JJ c� /�( /(7(/
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OWNER PROPERTY ADDRESS: I to (q., "1-0 ,✓ 4-I � /
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OWNER TELEPHONE NUMBER:
TAX MAP NO. : Section I -1 Block I Lot 7
CROSS STREET: Uk5 i
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing k
•
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: V,),. /1 �7
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: _ Q &
Town, erk's ff
ECEIV�D ice
DATE:
DEC 2 8I --
Tnwn Clerk Southold
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