HomeMy WebLinkAboutPrince OFFICE OF THE TOWN CLERK I IFO(k�,"
Town of Southold � � �
Judith T. Terry, Town Clerk Z
Town Hall, 53095 Main Road y '
P. O. Box 1179 4_; �� *S
Southold, New York 11971 ti Q �- •
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Telephone '01Xid
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 185 Residential x
Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: Frederic C. and Helen W. Prince
OWNER MAILING ADDRESS: Founders Path
Southold, New York 11971
OWNER PROPERTY ADDRESS: Founders Path
Southold, New Y6rk
OWNER TELEPHONE NUMBER: 516-765-3006
TAX MAP NO. : Section 64 Block 4 Lot 19
CROSS STREET: Landon Lane -
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: September 24, 1986
Judith T. Terr
Southold Town Clerk
DATE: December 22, 1986
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK ���FFO
Town of Southold O&O) -,. �CQG' , Application No.J1�
Judith T. Terry, Town Clerk �` , �
Residential
Town Hall, 53095 Main Road
P. O. Box 1179 cnI;J ;qeql Non-Residential
Southold, New York 119710 3 _z ��`
Telephone
(516) 765-1801 _ 1
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No//_5—
Fee $ / Q
DATE
OWNER NAME: rLe2 ie> )744//,'',
OWNER MAILING ADDRESS: ' • v J A
A0�4(1 07/
OWNER PROPERTY ADDRESS: 48//171P_)
OWNER TELEPHONE NUMBER: 410 71A-- 364
TAX MAP NO. : Section (,, 51 Block Lot ,/5
r
CROSS STREET: � I
,
TYPE OF SYSTEM: Septic Tank New _ Existing
''')‹Cesspool New Existing ><
Residential x Non-Residential
DATE OF PREVIOUS PUMP-OUT: 1,� o�/ 51 i 86
- I
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.) 1\1 1
, -Signature of Applicant
licant
9
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RECEIVED B Y: gc./Y_damCb _
R C lyEffown CI irk's Off'e
DATE: DEc 22 t) 7 ,�a81V CY 7-
Southold A r -"P