HomeMy WebLinkAboutPihl OFFICE OF THE TOWN CLERK
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Town of Southold ���-�4 �C
110:
'Judith T. Terry, Town Clerk A 4,4
Town Hall, 53095 Main Road h e ••,P. O. Box 1179 c � � _4
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Southold, New York 11971 _ ® O� •
Telephone .�( [
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 337 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool X
NAME OF OWNER: Ellen Ingram Pihl •
OWNER MAILING ADDRESS: Box:, 201 , 2235 Cedar Lane
East Marion, New York 11939
OWNER PROPERTY ADDRESS: 2235 'Cedar Lane
East Marion, New York
OWNER TELEPHONE NUMBER: 516-477-0728
TAX MAP NO. : Section 37 Block 4 Lot 7
CROSS STREET: Bayview Drive
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: December 1983
• Judith T. Terry
Southold Town Clerk
DATE: July 15-, 1987 - -
(TOWN SEAL)
II
OFFICE OF THE TOWN CLERK ���F(](�
X: C A lication No.
Town of Southold �® ,�, Q� pp ,3J�
Judith T. Terry, Town Clerk "'4,
Town Hall, 53095 Main Road '• "� Residential
P. O. Box 1179 cal i `' Non-Residential
Southold, New York 11971 O �C11: *-
Telephone ®(
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ v
DATE --/c/.1--y 9., 1 8 87
OWNER NAME: /Al a r2iim
OWNER MAILING ADDRESS: 2----V- 53-
--m 3SCe b �� L -Af 49c) }=7 )
OWNER PROPERTY ADDRESS: S /l/1 ,4-5 /4_0 a V�
OWNER TELEPHONE NUMBER: (57 6 4 7 7 - c 7 Z$
TAX MAP NO. : Section 3 7 Block ,4 Lot 7
CROSS STREET: ri " 43/9-VU/&-(4) ,026r/
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool L"'"' New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: D / '3
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.)
g„el,e4A Pd4LSignature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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