HomeMy WebLinkAboutRasanen OFFICE OF THE TOWN CLERK �W
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Town of Southold ;
Judith T. Terry, Town Clerks
Town Hall, 53095 Main Road
P. O. Box 1179Y �
Southold, New York 11971 Q •�
Telephone __(
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(516) 765-1801
TOWN, OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 294 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool X
NAME OF OWNER: Elsie Mabel Rasanen
OWNER MAILING ADDRESS: 3660 Westphalia Rnar1
Mattituck, New Ynrk 11952
OWNER PROPERTY ADDRESS: 3660 Westpahlis Road
Matttiuck, New York
OWNER TELEPHONE NUMBER: 516-298-4662
TAX MAP NO. : Section 113 Block g Lot 1-1'
CROSS STREET: ' Meday Avenue
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: April 8, 1986
Judith T. Terry
Southold Town Clerk
DATE: May 4,r 1987 -
(TOWN SEAL)
OFFICE OF THE TOWN CLERKl5v�F0((C
Town of Southold ® Q Application No. o?/q
4ti
Judith T. Terry, Town Clerk ,
Town Hall, 53095 Main Road r. : ,G Residential
S
P. O. Box 1179 ca-3 S` ` n �`' Non-Residential
Southold, New York 11971 Ok = ����•
Telephone "faiWNON-1.9
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. , °f y
Fee $ '1 b•
DATE g///A7
OWNER NAME: 1E /- /f, / �� P-14-
OWNER
MAILING ADDRESS: 463 krGS7- ///5z-L/,9- �C
( 4--T- C/Cf /
OWNER PROPERTY ADDRESS: S
OWNER TELEPHONE NUMBER: )1?--
TAX MAP NO. : Section ll, , Block Lot /3 "
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool / New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: LV/a-
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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.)
l ' Signature of Applicant
RECEIVED BY:
RECIFID Towr/Clerk' Office
DATE: t:1!W 04 19117
Town Clark Southold •
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