HomeMy WebLinkAboutPettit OFFICE OF THE TOWN CLERKiF�
Town of Southold ' � C��
-Judith T. Terry, Town Clerk • Z 4.1"0 ,
Town Hall, 53095 Main Road o A1
P. O. Box 1179 Er'- ..� •
Southold, New York 11971 p ® '°' ��
Telephone .olJo
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 398 Residential - X
Non-Residential
Fee $ 10.00
Septic Cesspool X
- NAME OF OWNER: Robert H. Pettit
OWNER MAILING ADDRESS: P.O. Box 78
Southold, New York 11971
OWNER PROPERTY ADDRESS: 515 Maple Lane
Southold, New York
OWNER TELEPHONE NUMBER: 516-765-2866 -
TAX MAP NO. : Section 64 Block 1 - Lot 26 _
CROSS STREET: Main Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: June 1985
•
eotoTer ��...,
Judith T. ���
Southold Town Clerk
DATE: August 13, 1987
7
(TOWN SEAL)
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firOFFICE OF THE TOWN CLERK 1c0FD(� lication 9 '
' App Town of Southold C ' No.°C �
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Judith T. Terry, Town ClerkResidential
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Town Hall, 53095 Main Road 4
P. O. Box 1179 crs � ' Non-Residential
Southold, New York 11971
Telephone411% '..'�
(516) 765-1801
TOWN OF -SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for -
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 02f''
Fee $
DATE TIM, ii 0E7
OWNER NAME: f oGe r •Lr fl-c rT-, r
OWNER MAILING ADDRESS: Ro £ ox 7g
So u c-D e
OWNER PROPERTY ADDRESS: .575- /IA-Pim LAVE.
coVT?f ot.-()
OWNER TELEPHONE NUMBER: T'$' -,xg(
TAX MAP NO. : Section 6 Block Lot � L
CROSS STREET: HI AiL) kr)
TYPE OF SYSTEM: Septic Tank New Existing K
Cesspool New Existing
Residential x Non-Residential
DATE OF PREVIOUS PUMP-OUT: J UJF
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.)
41d,(744/
Signature of Applicant
RECEIVED tvr .,,
Town Jerk's Office
DATE: AUG 13 1987
• Town Clerk Southold -
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