HomeMy WebLinkAboutSmith (3) OFFICE OF THE TOWN CLERK �` IX/re
Town of Southold OG
Judith T. Terry, Town Clerk fr L
Town Hall, 53095 Main Road
P. O. Box 1179 �� ;s °` %•
Southold, New York 11971 d •
Telephone ®1 sy,a
(516) 765-1801 = -
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT -
SEPTIC TANK or CESSPOOL
Operation Permit No. 625 Residential x
Fee $ 10.00 Non-Residential
Septic Cesspool _X
NAME OF OWNER: W. Kenneth Smith Jr.
OWNER MAILING ADDRESS: 1695 Smith Road
Peconic, New York 11958
OWNER PROPERTY ADDRESS: 1695 Smith Road
Peconic, New York
OWNER TELEPHONE NUMBER: 516-333-4323 (office) -
TAX MAP NO. : Section 98 Block 4 Lot 21
CROSS STREET: Indian Neck Lane
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
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diteF ry
Southold Town Clerk
DATE: February 25, 1988 -
(TOWN SEAL)
OFFICE OF THE TOWN CLERK `c3IFO ..Ur
Town of Southold 0'-, x • CQ -- , Application No. 26-/
Judith T. Terry, Town Clerk ,}R,
Town Hall, 53095 Main Road d°, - 1 Residential
P. O. Box 1179 U' e- Non-Residential
Southold New York 11971 O
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ O nv
DATE a - ®8 8
OWNER NAME: (,v ke iv iv e l k S,�v4 l JR--
OWNER MAILING ADDRESS: I OS- Sirn MPe"
P--c®4 lc N . / /95--R
OWNER PROPERTY ADDRESS: Sam
OWNER TELEPHONE NUMBER: 3-76- 3 33 _43a y CoCpc
��
/000
TAX MAP NO. : Section ct � /Block 171 Lot 2. /
CROSS STREET: _LYbiJ Aie**
TYPE OF SYSTEM: Septic Tank New Existing
_o see
rPL \„� Ae„ Cesspool New Existing
ND
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: k✓ dt N -1 9 "
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.)
Se_a cue
Signature of App
RECEIVED BY: detr'cd"
/j Town lerk's ffice
DATE: aia .5/ /
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