HomeMy WebLinkAboutStone OFFICE OF THE TOWN CLERK • .C3WFU(J'
Town of Southold �� �
Judith T. Terry, Town Clerk r °; �, �f
Town Hall 53095 Main Road _ z
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P. O. Box 1179 SAP � ` ` �$
Southold, New York 11971 ®‘- •
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 494 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool X
NAME OF OWNER: Albert H. and Frances C. Stone
OWNER MAILING ADDRESS: Town Harbor Lane
Southold, New York 11971
OWNER PROPERTY ADDRESS: Town Harbor Lane
Southold, New York
OWNER TELEPHONE NUMBER: 516-765-2075
TAX MAP NO. : Section 65 Block 1 Lot 3
CROSS STREET: Terry Lane
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
Judith T. rry
Southold Town Clerk
DATE: November 24, 1987
(TOWN SEAL) 1�
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OFFICE OF THE TOWN CLERK cOFOU{
Town of Southold �® �QG; Application No. y'
Judith T. Terry, Town Clerk ';
Town Hall, 53095 Main Road -r, : Residential
P. O. Box 1179 U' ' g Non-Residential
Southold, New York 11971 ® .E ` e
Telephone _ ( , .'
(516) . 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for-
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 9 9�
Fee $ /D;�'
DATE `' VG,
OWNER NAME: 66,r cY-- FI C$ C. S7a,tl
OWNER MAILING ADDRESS: / 06(..),V 4/0( e-4.
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OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: 76 6.7
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TAX MAP NO. : Section 6 3-' Block f Lot r f '
CROSS STREET: 1,4/1-0-11C1-1(..o--)
TYPE OF SYSTEM: Septic Tank / New Existing 1.7
Cesspool New Existing
Residential 11 Non-Residential
DATE OF PREVIOUS PUMP-OUT: /07/47
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 pplicant
RECEIVED BY:(4'jc.t
Rearm Town erk's ffice
DATE: A. t • 114
Trnn+n, rlArk Southold
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