HomeMy WebLinkAboutPlimpton OFFICE OF THE TOWN CLERK Ic51FU[/I�`,D
Town of Southold ` � .� , _
Judith T. Terry, Town Clerk r
Town Hall, 53095 Main Road
P. O. Box 1179
Southold, New York 11971p `
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Telephone . jid 10"
(516) 765-1801 `
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 249 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: Elizabeth J. Plimpton
- OWNER MAILING ADDRESS: Box 613
Cutchogue, New York 11935
OWNER PROPERTY ADDRESS: 12250 New Suffolk Avenue •
Cutchoque, New York
OWNER TELEPHONE NUMBER: 516-734-6731
TAX MAP NO. : Section 116 Block 6' Lot 11
CROSS STREET: Moores Lane
TYPE OF SYSTEM: Septic Tank New • Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: 1983 or 1984
•
Judith T. Terre
Southold Town Clerk
DATE: March 31 , 1987
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK c\c31FQu. =
Town of Southold 0� •- CQG�,, Application_ No. 07 lc?'
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road -< Residential
P. O. Box 1179 - ��' y�1 ;' Non-Residential
Southold, New York 11971 O ®
Telephone =®.! NiC°,-��
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. o? ✓
Fee $
DATE .� /1°7
OWNER NAME: //-z rkPit wto
OWNER MAILING ADDRESS: ak4,6, 6/-3
OWNER PROPERTY ADDRESS: / %11)Q.L.4-) •
OWNER TELEPHONE NUMBER: ) "3 V 693/
TAX MAP NO. : Section ,fj 6 Block 6 Lot l/
CROSS STREET: 41te.4
4,-2--
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool / New . Existing l—
Residential L Non-Residential
DATE OF PREVIOUS PUMP-OUT: � 3 Om-
LOCATION
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.)
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I
� ignatur-/.f Applica i
RECEIVED Et1
wn Cler s Office
DATE: ft'AR 3 0 1987
Town C;erk South*,