HomeMy WebLinkAboutPugsley OFFICE OF THE TOWN CLERK �S�FrUCIl��O
Town of Southold ,, Gy
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road : -
P. 0. Box 1179
Southold, New York 11971
Telephone � �.( 41016
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 115 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool x
NAME OF OWNER: James W. Pugsley
OWNER MAILING ADDRESS: P.O. Box 84
New Suffolk, New York 11956
OWNER PROPERTY ADDRESS: Jackson and Second Streets
New Suffolk, New 'York
OWNER TELEPHONE NUMBER: <516-.734-6868
TAX MAP NO. : Section 117 Block 10 Lot 21
CROSS STREET: Second Street
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: 1983
Judith T. Terry
Southold Town Clerk
DATE: October 30, 1986
(TOWN SEAL) •
. ,,�
OFFICE OF THE TOWN CLERK COFU(i =
Town of Southold �� tM0.6% Application No. /L5
Judith T. Terry, Town Clerk 4 %) Residential
Town Hall, 53095 Main Road a azE -
P. O. Box 1179 Rem��' Non-Residential
Southold, New York 11971 O0 •s �0 ,���
Telephone = .(
(516) 765-1801
RECEIVE® TOWN OF SOUTHOLD
OCT 271966 SOUTHOLD WASTEWATER DISPOSAL DISTRICT
Town Clerk Southold
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. //3"
Fee $ /069
DATE A /.
.,r
OWNER NAME: --- /e:M'If= . ?GSLE
OWNER MAILING ADDRESS: Re_ Bk' ec>$.
F , L,fi6 //�1 ,K . M6
OWNER PROPERTY ADDRESS:
/A) Ati." . //9cq
OWNER TELEPHONE NUMBER: L6-7 — —
TAX MAP NO. : Section / i7 —/ . Block Lot
CROSS STREET: ��U�fibe
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: / 96
LOCATION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow and feet
6/1 of distance, approximately, to building and closest road.)
1 V .11j`r
( ,to
Si natur of • pp' icant
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aeapie
RECEIVED
Town C rk's Office
DATE: a 0- /Yfli