HomeMy WebLinkAboutStapon OFFICE OF THE TOWN CLERK cOFNiro
Town of Southold � , Ol/
Judith T. Terry, Town Clerk Z n
Town Hall, 53095 Main Road o � •
P. O. Box 1179 i` cr3
Southold, New York 11971O�-
Telephone _ Ql
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
•
Operation Permit No. 460 Residential X
Non-Residential
Fee $ 10.00
Septic - Cesspool x
NAME OF OWNER: Fannie Stapon
OWNER MAILING ADDRESS: 3854 Oaklawn Avenue Ext.
Southold, New York 11971
OWNER PROPERTY ADDRESS: 3854 Oaklawn Avenue Ext.
Southold, New York
OWNER TELEPHONE NUMBER: 516-765-2576
TAX MAP NO. : Section 70 Block 10 Lot s:8
CROSS STREET: Custer Avenue
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: May 7, 1987
60044;e •
Judith T. erry
• Southold Town Clerk
DATE: October 13, 1987
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK coFour --
Town of Southold �� CQG Application No. ' rge,
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road Residential
P. O. Box 1179 cry t Non-Residential
Southold, New York 11971
Telephone ! a
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ //) 00
DATE /2 e7
9 _
OWNER NAME:
OWNER MAILING ADDRESS: _3.53sq q Da u,(,nyiL U'v- ,
Svc, -ke--CA; fry/
OWNER PROPERTY ADDRESS: \54 vne.
OWNER TELEPHONE NUMBER: /b 176 ,)...6-7b
•
TAX MAP NO. : Section 70 Block /0 Lot 11
CROSS STREET: eu_S e Y 7-, velli t/2
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool 17" New Existing
Residential �/ Non-Residential
DATE OF PREVIOUS PUMP-OUT: ,57- 1 — V.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.)
Signature ofJApplicant
RECEIVED BY•l „.s
o" /Clerk's Office
DATE: OCT 0 91987
Town Clerk Southold
Aieck Poi9c/
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