HomeMy WebLinkAboutReedOFFICE OF THE TOWN ICLtiER%k
Town of Southold
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road
P. O. 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. 108
Fee $ 10.00
NAME OF OWNER: Susan and John Reed
Residential X
Non -Residential
Septic Cesspool X
OWNER MAILING ADDRESS: P.O. Box 76
New Suffolk, New York 11956
OWNER PROPERTY ADDRESS: Old: -Harbor Road
New Suffolk, New York
OWNER TELEPHONE NUMBER: 516-734-6475
TAX MAP NO.: Section 117
Block 03 Lot 010 _
CROSS STREET: New Suffolk Road
TYPE OF SYSTEM: Septic Tank
New
Cesspool 117 New
Residential X
DATE OF PREVIOUS PUMP -OUT: 1984
DATE: October 22, 1986
Existing
Existing 10
Non -Residential
_ J
Judith T. Terr
Southold Town Clerk
(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
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Southold
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. /017
Fee $ /0
Application No. -/.Or
Residential W
Non -Residential
DATE
OWNER NAME:
OWNER MAILING ADDRESS /P0 • �4v
Au 7S�
OWNER PROPERTY ADDRESS: �L� M�40"e L�
OWNER TELEPHONE NUMBER: S/(so ) -3 tI Cv �! %
J
TAX MAP NO.: Section �� Block 63 Lot ®/D
CROSS STREET: �� ti �c 6%q y
TYPE OF SYSTEM: Septic Tank_ !/ New
Cesspool
New
Existing
Existing
Residential a Non -Residential
DATE OF PREVIOUS PUMP -OUT:
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.)
9
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Signature of Applicant
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RECEIVED BY:
Town Cler 's Offic
DATE:
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