HomeMy WebLinkAboutStearns (2) OFFICE OF THE TOWN CLERK • 'cOFUCI►(e;"
Town of Southold •�W, �G
Judith T. Terry, Town Clerk ; L'
Town Hall, 53095 Main Road ;, v-,-Atilt X
P. O. Box 11791,1f: 11,---
Southold, New York 11971 Qy' �O�-��•�
Telephone ' "'� 4zli
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 353 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool X
NAME OF OWNER: Robert D. Stearns
OWNER MAILING ADDRESS: 4736 Charing Cross Road
Sarasota, Florida 34241
OWNER PROPERTY ADDRESS: 225 East Side Avenue
Mattituck, New York 11952
OWNER TELEPHONE NUMBER: 813-377-9007
TAX MAP NO. : Section 99 Block 3 Lot 20
CROSS STREET: East Side Avenue and -Harbor View Avenue
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool x New Existing x
Residential x Non-Residential
DATE OF PREVIOUS PUMP-OUT: 1982
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Judith T. Terry
Southold Town Clerk -
DATE: . July 1.5, 1987 -
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(TOWN SEAL)
4
71111 • e
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OFFICE OF THE TOWN CLERK ��FF�(�. '= -
Town of Southold � t =. CQ�_ Application No. 3
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road < 7 Residential
P. O. Box 1179 �V44 ' �: Non-Residential
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Southold, New York 11971 ® �®. i �J
Telephone , _ol )\� .-�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE 7//d/t 7
OWNER NAME: g/8&ieT V �T 142iVU1
OWNER MAILING ADDRESS: 4/73c G3,43nJ,aG. azass-
69,0e6Ed7-19
ja, 72. 34
OWNER PROPERTY ADDRESS: da,S- ��T i� eUh
A497-7-ify/cs V 1/f,C31-
OWNER TELEPHONE NUMBER: (i J 377 - 7007
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TAX MAP NO. : Section - 0p..0-0 Block 03 4/1?"D Lot
CROSS STREET: AlST 05;v4- Y/ /,fax
TYPE OF SYSTEM: Septic Tank New - Existing
Cesspool X New Existing X
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: �78 ,
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.)
f Sig 'tu of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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