HomeMy WebLinkAboutSidor OFFICE OF THE TOWN CLERK - FE1 -
Town of Southold Q�� CDy
Judith T. Terry, Town Clerk ;�
Town Hall, 53095 Main Road `6__
P. O. Box 1179
Southold, New York 11971 •
Telephone 01 4i-''N�
(516) 765-1801 n
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
- OPERATION PERMIT
SEPTIC TANK or CESSPOOL - -
Operation- Permit No. 403 Residential X
Fee $ 10.00 Non-Residential
- -- Septic Cesspool X
- NAME OF OWNER: Edward Sidor
OWNER MAILING ADDRESS: RD 1 , Box 166A
Mattituck, New York 11952
OWNER PROPERTY ADDRESS: Grand Avenue
Mattituck, New York 11952
- OWNER TELEPHONE NUMBER: 516-298-8810
TAX MAP NO. : Section 139 Block 4 Lot 9.1
CROSS STREET: Freeman Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New ExistingX
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: December 1984 •
.1._!!"t-h, T. Terry
Southold Town Clerk
DATE: August 17, 1987
(TOWN SEAL)
OFFICE OF THE TOWN CLERK
Town of Southold v.,4044-, CQ ' Application No. 4/16,3Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road C, ,. t, '"
< Residential
P. O. Box 1179 ' ' `� Non-Residential
Southold, New York 11971 ® ® � �`
Telephone : .( �
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. Gi03
Fee $ j '
DATE
OWNER NAME: ED1.09.4D .S/JOoie
OWNER MAILING ADDRESS: l ,3 %/46
.7—(1c,/e-,, ,/G/7 //PP
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: 57 — 7 /O
/39 -- V-7-411
TAX MAP NO. : Section /3 Block o 7 Lot /
CROSS STREET: F/ -
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool x New Existing A
Residential ` ` Non-Residential
DATE OF PREVIOUS PUMP-OUT: j, C/
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.)
0,444dCIJ 14--4Z4
Signature of Applicant
RECEIVED BY: G �
Towr9Clerice
DATE:
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