HomeMy WebLinkAboutRadford OFFICE OF THE TOWN CLERK • Wire'
Town of Southold #41.-
,
Judith T. Terry, Town Clerk • Ay �
Town Hall, 53095 Main Road a
P. O. Box 1179 u-3 �
Southold, New York 11971 p' ®� ` •`
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Telephone 1`
(516) 765-1801 `
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 348 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: Stella S. RAdford
OWNER MAILING ADDRESS: P.O. Box 1430
Mattituck, New York 11952
OWNER PROPERTY ADDRESS: Pacific' Street
Mattituck, New York
OWNER TELEPHONE NUMBER: 516-298-8556
TAX MAP NO. : Section 141 Block 4 Lot 42
CROSS STREET: Main Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREY IO,US PUMP-OUT: Approx. 1980 -
Judith T. Terry
Southold Town Clerk
DATE: July 15, 1987
(TOWN SEAL) -
4
OFFICE OF THE TOWN CLERK �FFD(,���"
Town of Southold �� ra % Application No. Ycri
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road Residential
P. O. Box 1179 cry �. �' Non-Residential
Southold, New York 11971 - ?' • $
Telephone - 1
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ ,C)
DATE Jul1 (® . 1Ti7
OWNER NAME: S f f L L1 i ll- J' Chir ,b
OWNER MAILING ADDRESS: PCS; i 5X
MAT-T 1 i u , //1- 50-
OWNER
/ ; 0-
OWNER PROPERTY ADDRESS: 'PA Ci F/ C S 1 rE
OWNER TELEPHONE NUMBER: (51( ) 7 /f- f556
TAX MAP NO. : Section /1/1 Block Lot 412.
CROSS STREET: 1 4 //t-j 'OM)
CTZ
TYPE OF SYSTEM: Septic Tank New Existing
VCesspool New Existing I/
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: ,60a--7- / 9 10 • eceii1 "M 7
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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Signature of Applicant Or `
RECEIVED BY:
Town Clerk's Office
DATE:
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