HomeMy WebLinkAboutPilles (2) 4,044:4-
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Town Hall, 53095 Main Road
i&fto ���� P.O. Box 1179
=®��® 1�i `" ,'�'. Southold, New York 11971
JUDITH T.TERRY 0' FAX(516)765-1823
TOWN CLERK lt TELEPHONE(516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1325-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner PILLES, THOMAS R.
Mailing Address 1 MAIN ROAD
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 MAIN ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-56811
Tax Map No. section 75 block 2 lot 4)
Cross Street SOUTH HARBOR ROAD
Date Of Last Pump Out 1/01/87
Issue Date: 11/30/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK 'cSFO(,r�
Town of Southold Q - �� Application No.
Judith T. Terry, Town Clerk ,
Town Hall, 53095 Main Road $10.00 - Residential
P. O. Box 1179 cry ,`.: A
`O' �. $25.00 - Non-Residential
Southold, New York 11971 ® ��•
Telephone ./0 •
'
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
•
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. /202_5
Fee $ /fj 00
DATE 10/?Wg7
OWNER NAME: 1-174,440cyq loci((es
OWNER MAILING ADDRESS: j// 'ovD f •SOU tti.eLO , IAV - 0?/
OWNER PROPERTY ADDRESS: (VA ) pp �,�) . C.) LAP 971
OWNER TELEPHONE NUMBER: 7(
TAX MAP NO. : Section 7.5 Block ca Lot 44
CROSS STREET: Ln f-Fe r 80761.4
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential G/ Non-Residential
DATE OF PREVIOUS PUMP-OUT: / ' #j'Y6t S�
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.)
"I/
Signat 're of Applicant
RECEIVED BY: 447.4041100'
clerk' Office
DATE: OCT 3 819bi
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