HomeMy WebLinkAboutPott OFFICE OF THE TOWN CLERK
Town of Southold
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road ..
P. O. Box 1179 •
Southold, New York 11971 *?,
TelephoneaVa *6 '
, (516) 765-1801 '
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 453 Residential x
Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: Nicholas Pott with Michael and Ruth Wortis -
OWNER MAILING ADDRESS: P.O. Box 318
Southold, New York 11971
•
-'"' OWNER PROPERTY ADDRESS: Emerson Drive off South Harbor Road
Southold, New York 11971
.'w OWNER TELEPHONE NUMBER: 516-765-1903
TAX MAP NO. : Section 86 Block 3 Lot 1
CROSS STREET: Hiawatha's Path
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: August 21 , 1985
•
Judith T. erry
Southold Town Clerk
•
DATE: October 8, 1987
• (TOWN SEAL)
giiOf
OFFICE OF THE TOWN CLERK c0FO(it' '
Town of Southold �® IQ % . Application No. Y S3
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road V ' ',y` ' Residential
P. O. Box 1179 �' ' r '` Non-Residential
Southold, New York 11971 O ON /
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /6
DATE I7- 7
OWNER NAME: hI t ct7 1, i ?Qtt wva ti - °` vki
Oetrij
OWNER MAILING ADDRESS: P ® &OX 312
So u. o Cdr
OWNER PROPERTY ADDRESS: Fr^C50-.1 DR4e- t5. 444.40r
OWNER TELEPHONE NUMBER: 76 S- ( 9 0 3
TAX MAP NO. : Section O$ 6 Block 3 Lot I
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing V
Residential V ' Non-Residential
DATE OF PREVIOUS PUMP-OUT: 8. 2-i- 8S 9 '3' 51)
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.)
NI:442 )61°-t7
L
Signature of Applicant
RECEIVED BYe'd
Clerk' Office
DATE: T 0 8 11;1
Town Clnels Southold
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