HomeMy WebLinkAboutStype OFFICE OF THE TOWN •CLERK 6 �c.FFUUrCOG
Town of Southold
Judith T. Terry, Town Clerk Z ;' 4•''ti*tof
Town Hall, 53095 Main Road c ' } A V: �fn
P. O. Box 1179 cn = kt M.
Southold, New York 11971 p ‘e*,..'"). Nr-
Telephone Telephone 1zit
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 387 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool X
NAME OF OWNER: Valentine W. Stype
OWNER MAILING ADDRESS: Oregon Road
Cutchoque, New York 11935
OWNER PROPERTY ADDRESS: Oregon Road
Cutchogue, New York 11935
OWNER TELEPHONE NUMBER: 516-734-6172
TAX MAP NO. : Section 95 Block 1 Lot 7
CROSS STREET: Aliah's Lane
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: 1985
Judith T. Te
Southold Town Clerk
DATE: August 5, 1987
(TOWN `SEAL)
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OFFICE OF THE TOWN CLERK COFU(,-�' p/�
Town of Southold �� -, # CQG Application No.&d
Judith T. Terry, Town Clerk t • ..•- ••• Residential
Town Hall, 53095 Main Road o ..4.jk .
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P. O. Box 1179 ul 4 ,;:j : Non-Residential
Southold, New York 11971
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. (32O
Fee $
DATE R/L7/8
OWNER NAME: tale
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OWNER MAILING ADDRESS: ► ,, CP
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OWNER PROPERTY ADDRESS: �rO�
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OWNER TELEPHONE NUMBER: 7,3(7-- 6.
TAX MAP NO. : Section 74 Block I Lot 7
CROSS STREET: qJirtf �-�
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing [/
Residential Non-Residential
- - DATE OF PREVIOUS PUMP-OUT: .1 q
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.)
e /
Signature of Ap. cant
RECEIVED BY." `�,a-
RECEW DTown f Jerk'_s •fffice
DATE: Ann 051987
Town Clerk Southold
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`1 $47
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