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OFFICE OF THE TOWN CLERK ' ‘AFElpK
Town of Southold
Judith T. Terry, Town Clerk � . .e
- Town Hall, 53095 Main Road
P. O. Box 1179 tri
Southold, New -York 11971 _= o %),%`.119
c t-•
Telephone __1
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 64 Residential XX
Non-Residential
Fee $ 10.00 Septic Cesspool XX
NAME OF OWNER: William B and Mary Strickland
OWNER MAILING ADDRESS: 54 William Street
Hempstead, New York 11550
OWNER PROPERTY -ADDRESS: - - 11900-Soundview -Avenue
Southold, New York
OWNER TELEPHONE NUMBER: 516-486-0981
TAX, MAP NO. : Section 54 Block 6 Lot 17
CROSS STREET: Booth Road
TYPE OF SYSTEM: Septic Tank - New Existing
Cesspool XX New XX Existing
Residential XX , Non-Residential
DATE OF PREVIOUS PUMP-OUT: New system
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Judi . Terry
Southold Town Clerk
DATE: September 23, 1986
(TOWN SEAL)
.. .,
OFFICE OF THE TOWN CLERK 9, /
Town of Southold D�� �®Gt,� Application No.6 �r
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road ~ - 4-A Residential
P. O. Box 1179y' ; Non-Residential
Southold, New York 11971 OO �O� ��`
Telephone ,( * s '/
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for-
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 6 y
Fee $ `O
DATE SEPT /f /.9e,‘
OWNER NAME: 0/4A/A". • 11006 /119/zy CrRteXi-ifis>0
OWNER MAILING ADDRESS: rt tic, 6T/?erET
/7141-01,16740-n 4/•c/. // S-7'
OWNER PROPERTY ADDRESS: //fee SouyA v/e-./..../ "54/e'kvu6
-5 0u%FD�¢ / /U•y
OWNER TELEPHONE NUMBER: 1-7 - c{ p6 -Qqy/
TAX MAP NO. : Section 54 Block 6 Lot ( 7'
CROSS STREET: &C%ff (Roof?
TYPE OF SYSTEM: Septic Tank New -- Existing
Cesspool v New ` Existing
Residential — Non-Residential
DATE OF PREVIOUS PUMP-OUT:d ll-as ` �� �.t,f ! ,/ ���, Pe-r i e-ypoor�
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.)
Signature of Applicant
RECEIVED BY: r Wit c, I
Town Cle ,k's Offi' e
DATE: t
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