HomeMy WebLinkAboutRay (2)OFFICE OF THE TOWN CLERK
Town of Southold
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road
P. 0. Box 1179
Southold, New York 11971
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 354
Fee $ 10.00
Residential X
Non -Residential
Septic Cesspool X
NAME OF OWNER: Wilbur Lloyd Ray
OWNER MAILING ADDRESS: P.O. Box 320
Greenport, New York 11944
OWNER PROPERTY ADDRESS: 711 Front Street
Greenport, New York
OWNER TELEPHONE NUMBER: 516-477-0535
TAX MAP NO.: Section 48 Block 1 Lot 10
CROSS STREET: Seventh Street
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non -Residential
DATE OF PREVIOUS PUMP -OUT: March 1987
Judith T. Terry
Southold Town Clerk
DATE: Jud 15-, 1987
(TOWN SEAL)
OFFICE OF THE TOWN CLERK
Town of Southold
Judith T. Terry, Town Clerk
Town Hall,_ 53095 Main Road
P. 0. Box 1179
Southold, New York 11971
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
Application No.3�`�
Residential t/
Non -Residential
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
1
APPLICATION
- - - for - - -
OPERATION 'PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
OWNER NAME:
OWNER MAILING ADDRESS:
DATE
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: 77-^ &-25-
3
TAX MAP NO.: Section Block Lot
CROSS STREET: fi 4417 -T�-
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non -Residential
DATE OF PREVIOUS PUMP -OUT: j F 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.)
RECEIVED BY:
Town Clerk's Office
DATE:
Signature ofplicant
-A
A 01
4
RAYS/-
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