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Town of Southold � revt G
Judith T. Terry, Town Clerk � T
Town Hall, 53095 Main Road , F }}
P. O. , Box 1179 , `
Southold, New York 11971 �`YQ " - '`'' , = �- •�
Telephone 0l
(516) 765-1801
TOWN OF. SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 88 Residential XX
Fee $ 10.00 Non-Residential
Septic Cesspool XXC
NAME OF OWNER: William and Marie Strasser
OWNER MAILING ADDRESS: 617 West Street
Greenport, New York 11944
OWNER PROPERTY ADDRESS: 617 West Street '
Greenport, New York
OWNER TELEPHONE NUMBER: 516-477-1368
TAX MAP NO. : Section 42 Block 1 Lot 4
CROSS STREET: Sixth Avenue
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool XX New Existing XX
Residential XX Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
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Judith T. Terry
Southold Town Clerk
DATE: October 10. 1986
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK �FFO(,r.„`
Town of Southold 4 $ _.7 , Application No. gri
Judith T. Terry, Town Clerk "'
Residential
Town Hall, 53095 Main Road
P. 0. Box 1179m Non-Residential
Southold, New York 11971 OO `. �'.�0�,���`�
Telephone : .� �► , .
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. ef-d
Fee $ /0 (---0-0
DATE /0/747-(0 0/747-(o
OWNER NAME: l LLQ tiJ /114,410 '3‘7-1e)Xt
OWNER MAILING ADDRESS: 6. (7 1JES7- - ,3-7---
27 „y, /f ?9Y
OWNER PROPERTY ADDRESS: t!p(`� 4Sv
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OWNER TELEPHONE NUMBER: /77----/ a6 r
TAX MAP NO. : Section 42— Block 1 Lot
CROSS STREET: j / 4 Tl-/ A/ E
TYPE OF SYSTEM: Septic Tank New Existing /
Cesspool t/ New Existing ' 1/
Residential i/ 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.)
Signature of Applicant
RECEIVED BY:
Town lerk's Office
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DATE: /01 /,fte
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