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HomeMy WebLinkAboutPower . T OFFICE OF THE TOWN CLERK 011itAr‘'/"}Town of Southoldo �. Judith T. Terry, Town Clerk r'X �,, r �. Town Hall, 53095 Main Road a rAz4 P. O. Box 1179 � ' r 4rn .4,` . Southold, New York 11971 G' {n. �`r Telephone < (516) 765-1801 � � TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT OPERAT ION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. , -- --71 .2. Residential X Non-Residential Fee $ 10.00 Septic Cesspool X Kevin D. and Sue Ann Power NAME OF OWNER: Richard C. and. Karen M. Power OWNER MAILING ADDRESS: 11 Thruway Drive Bridgewater, New Jersey 08807 OWNER PROPERTY ADDRESS: 2600 Ole Jule Lane Mattituck, New York OWNER TELEPHONE NUMBER: 301-725-2782 TAX MAP NO. : Section 122 Block 4 Lot 14 CROSS STREET: Kraus Road TYPE OF SYSTEM: Septic Tank New Existing Cesspool X New Existing X Residential X Non-Residential DATE OF PREVIOUS PUMP-OUT: June 1, 1987 Judith T. Terry Southold Town Clerk DATE: July 30, 1987 (TOWN SEAL) • .. OFFICE OF THE TOWN CLERKF�(/�.'= Town of Southold T �®� > .- 4 ,- Application No. 77 <`I Residential /\ Judith T. Terry, Town Clerk �a Town Hall, 53095 Main Road c - P. O. Box 1179 v' Non-Residential Southold, New York 11971 ® ® Lr";•,..-r-;,`r Telephone _ (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ • n DATE 7 � t7 i<EVlm A4L See ELK ..Kp1 iB`Alvi / OWNER NAME: ,c. 14-R.D `�,, a. .I ,Y\ F-fL OWNER MAILING ADDRESS: '( ( w A/ IRA c�LAI AT.a. l� ® S8 07 OWNER PROPERTY ADDRESS: A460 Q .-E su.L. tYl A-17 A T1.x c.4 OWNER TELEPHONE NUMBER: ,(91,0.1) 7015 TAX MAP NO. : Section i'aA Block Lf Lot k ljt CROSS STREET: TYPE OF SYSTEM: Septic Tank New Existing Cesspool x New Existing X Residential Non-Residential - DATE OF PREVIOUS PUMP-OUT: e'.► 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.) Signature of Applicant RECEIVED BY: Town Clerk's Office DATE: I s Lr4rJ E. N Si--- % 42041-1 I . ,� f®© ` V -