HomeMy WebLinkAboutStiles OFFICE OF THE TOWN CLERK • c.gfUlf(I'
Town of Southold oQ O'
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road i..4*
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P. 0. Box 1179
Southold, New York 11971 p ® , Q��•�
Telephone Q( 0�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 396 - 397 Residential X
Fee $ 20.00 Non-Residential
Septic Cesspool X
NAME OF OWNER: William H. Stiles
OWNER MAILING ADDRESS: 18 Cider Mill Road
Stamford, Connecticut 06903
OWNER PROPERTY ADDRESS: New Suffolk Avenue (P.O. Box 494)
Cutchogue, New York 11935
OWNER TELEPHONE NUMBER: 516-734-6972
TAX MAP NO. : Section 116 Block 6 Lot 14
CROSS STREET: Meadow Lane
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool 2 systems New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
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Ju.ith err
Southold Town Cl-rk
DATE: August 11 . 1987
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK �S\\FF0(A-,'=
Town of Southold ��% CQ- Application No. 9G _� ..2
Judith T. Terry, Town Clerk ` Z ; { �'`) Residential
Town Hall, 53095 Main Road o y P. O. Box 1179 �' `` . Non-Residential
New York 11971 0 :,F �`�
Southold, -41,-,- ._,&- �,
Telephone -77_ .1 '�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ ,. --
DATE /ic7 ) s-
OWNER NAME: Ot I1LLL
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_ �r I L ES
OWNER MAILING ADDRESS: /(8 C, 0-iiL /7) 1 L_(_ R_6,
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OWNER PROPERTY ADDRESS: E, LAA SU c F OL `�4--i✓�fi /:a / `IetLI
_u 9---c_41-00-6/e_ .y, 1.( q S-S-
OWNER TELEPHONE NUMBER: f--1 (-4 — 6 �el' �
TAX MAP NO. : Section 1l t Block 6 Lot I LI
CROSS STREET: S/1.a7oc iJ &I "-'
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool v New Existing
Residential IV Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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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Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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