HomeMy WebLinkAboutStrong (2) OFFICE OF THE TOWN CLERK c5\Gl Q(xC,
Town of Southold � v �G -
Judith T. Terry, Town Clerk •� r � L.
Town Hall, 53095 Main Road tr
P. O. Box 1179 4 , 1
Southold, New York 11971 tb.,
Telephone .._0l
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
.SEPTIC TANK or CESSPOOL
Operation Permit No. 159 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool X
NAME OF OWNER: David Strong
OWNER MAILING ADDRESS: P.O. Box 1033
Mattituck, New York 11952
OWNER PROPERTY ADDRESS: Camp Mineola Road
Mattituck, New York
OWNER TELEPHONE NUMBER: 516-298-4770 -
TAX MAP NO. : Section 122 Block 9 Lot
CROSS STREET: Alois Land
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Never done
Judith T. Terr
Southold Town Clerk
DATE: December 1 , 1986
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(TOWN SEAL)
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OFFICE OF THE TOWN CLERK cVFFU
Town of Southold .- SG': Application No. 4SY
Judith T. Terry, Town Clerk „ ., ' ‘'N Residential
Town Hall, 53095 Main Road op.
P, O. Box 11794- �z Non-Residential
Southold, New York 11971
-�v - Off- ••
Telephone it •
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. /67
Fee $• f�•.
DATE ?/��/O f
OWNER NAME: fY,�-oil 5t6P.U/YC9
OWNER MAILING ADDRESS: C4Y(115 J / 23 3
/" (1” ,,h.c/ f' Y dera
OWNER PROPERTY ADDRESS: eK, `'
OWNER TELEPHONE NUMBER: 57(-- 0213 4(9��
TAX MAP NO. : Section /ac? Block 9 Lot
CROSS STREET: 'Ye,
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential fi' Non-Residential
DATE OF PREVIOUS PUMP-OUT: /t/FL',i,
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 o Applicant
RECEIVED BY: 64,1 a,
Town/Clerk's Office
DATE: fk ECEMD
DEC 01 sal
Town Clerk SoothOOd
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