HomeMy WebLinkAboutSteele OFFICE OF THE TOWN CLERK •��FF
Town of SoutholdOl/
Judith T. Terry, Town Clerk ; ' '' µ- 4'
Town Hall, 53095 Main Road
P. O. Box 1179 % W
Southold, New York 11971 p ��,
Telephone ' �,(�« /t`"
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 143- Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: Priscilla Tandy Steele
OWNER MAILING ADDRESS: 15405 Main Road, Box 1115N
Mattituck, New York 11952
OWNER PROPERTY ADDRESS: 15405 Main Road
Mattituck, New York
- OWNER TELEPHONE NUMBER: 516-298-8533
TAX MAP NO. : Section 114 Block 6 Lot 3
CROSS STREET: Village Lane
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: December 1985eSreasee440°.
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Judith T. Terry
Southold Town Clerk
•
DATE: November 13, 1986
(TOWN SEAL) -
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OFFICE OF THE TOWN GALE* �cVFFO(f{�,'
Town of SoutholdGApplication No.
Judith T. Terry, Town Clerk .44%
.6'1 L/
Town Hall, 53095 Main Road „. , ` s% ''4 Residential
O Com,.t3 S:
P. O. Box 1179 � i . Non-Residential
Southold, New York 11971 %O ® „ •�
Telephone : 1 ��•
(516) 765-1801 '
TOWN OF SOUTHOLD
RECEIVED
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OCT 071955
Town Clerk Southold APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. / 3
v°
Fee $ 1
DATE I o/ 4(cCI,
OWNER NAME: • 4-1-e-QXP_
OWNER MAILING ADDRESS: 18(4a 5 Na 2da lUX/ 1
')c O-AA f.2, Vl (3 1 l q.S
OWNER PROPERTY ADDRESS: -
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OWNER TELEPHONE NUMBER: Q-( H 25 33
TAX MAP NO. : Section 7��' Block Lot L3
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: I g�
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.)
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Pignature of Applicant
RECEIVED BY: , c
Town Cl:f k's Office
DATE: REM E
Town CM Southold
7 VI S 1
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