HomeMy WebLinkAboutSidor (4) OFFICE OF THE TOWN CLERK I • FU
Town of Southold 0�� •- �C�
Judith T. Terry, Town Clerk01417
Town Hall, 53095 Main Road o `£ ' r'
P. O. Box 1179 :� •�
Southold, New York 11971 p ' ®. -' �� •'
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Telephone
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. `306 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool X
NAME OF OWNER: John Sidon
OWNER MAILING ADDRESS: 4450 Mill Lane
Mattituck, NY 11952
OWNER PROPERTY ADDRESS: 4450 Mill Lane
Mattituck, New York
OWNER TELEPHONE NUMBER: 516-298-8512
TAX MAP NO. : Section 100 Block 4 Lot 2
CROSS STREET: Oregon Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Pumped every two years
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Judith T. Terr
Southold Town Clerk
, DATE: May 19. 1987
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK c3VFFU(,(��'—
Town of Southold C A lication No. (0
Judith T. Terry, Town Clerks %) Residential
Town Hall, 53095 Main Road 8 ; , �i
P. O. Box 1179 cn ' hi ` Non-Residential
Southold, New York 11971 ® ^'
Telephone -71411-47)\‘ '
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(516) 765-1801
TOWN OF SOUTHOLD
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SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
—for - - --
OPERAT ION PERMIT
SEPTIC TANK or CESSPOOL
r ' Operation Permit No.
Fee $ /0
DATEM , / I it 7
OWNER NAME: ,
... 406(-1.—
OWNER MAILING ADDRE S: f,Lt,S )9 Q -2\..
j )1 :7 . /if�"Z
OWNER PROPERTY ADDRESS: %% �
OWNER TELEPHONE NUMBER: S,f ,,
TAX MAP NO. : Section /Op Block 1/ Lot OU
CROSS STREET: 1
TYPE OF SYSTEM: Septic Tank New Existing . .
Cesspool / New Existing
V
Residential r/ Non-Residential
DATE OF PREVIOUS PUMP-OUT: cfica
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.)
Signature of Applicant
RECEIVED BY:C � _
Town rk's Of ice r='
DATE:
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