HomeMy WebLinkAboutQuintana OFFICE OF THE TOWN CLERK • icgf01./(p
Town of Southold y
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Judith T. Terry, Town Clerk {
Town Hall, 53095 Main Road 41-
P. O. Box 1179
Southold, New York 11971
Telephone ( kit
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 381 Residential X
Fee $ 10.00 l Non-Residential
Septic Cesspool X
NAME OF OWNER: Arthur and Marilyn Quintana
OWNER MAILING ADDRESS: Box 61
East Marion, New York 11939
OWNER PROPERTY ADDRESS: Old Orchard Lane
East Marion, New York
OWNER TELEPHONE NUMBER: 516-477-1437
TAX MAP NO. : Section 31 Block 7 Lot 14
CROSS STREET: Dogwood Lane
TYPE OF SYSTEM: Septic Tank New Existing
- 'Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Never preatiously pumped
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Judith T. Terr
Southold Town Clerk
DATE: August 3, 1987
(TOWN SEAL)
OFFICE OF THE TOWN CLERK �FFD(r
Town of Southold ��® ,. y , �i�': Application No..��
Judith T. Terry, Town Clerk Wit, `.: t
Town Hall, 53095 Main Road Residential
P. 0. Box 1179 �' Y • Non-Residential
Southold, New York 11971 'IA-
Telephone
-
Telephone 411 V:
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. , 3r(
0 D
Fee $
DATE ' � (t3 6 6 /
OWNER NAME: )2. ) A 1 11
OWNER MAILING ADDRESS: ()X G I. Old
OWNER PROPERTY ADDRESS: CD IrA 1- t1Y1ziAs6A
OWNER TELEPHONE NUMBER: (�iJ
TAX MAP NO. : Section g i .) Block Lot
CROSS STREET;Dr) e� 1J 0 0b. 1,4\
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential 1,7 Non-Residential
DATE OF PREVIOUS PUMP-OUT: 40"c le_
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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Signatu e of App icant
RECEIVED BY: r
REav Town C rk's 0 f ce
DATE: AN 03 19R7
Town Clerk SouthOld
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