HomeMy WebLinkAboutSwanson OFFICE OF THE TOWN CLERK . OUrez,
Town of Southold �QOfj
Judith T. Terry, Town Clerk •
Town Hall 5305 Main Road ~ °
P. 0. Box 1179 v3 ' '�
Southold, New York 11971
Telephone �l 411
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 531 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool X
NAME OF OWNER: W. Theodore Swanson
OWNER MAILING ADDRESS: 1345 Ships Drive
Southold, New York
OWNER PROPERTY ADDRESS: 1345 Ships Drive
Southold, New York 11971
OWNER TELEPHONE NUMBER: 516-765-5735
TAX MAP NO. : Section 79 Block 3 Lot 37
CROSS STREET: North Bayview Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: March 1984
Judith T. Te y
Southold Town Clerk
DATE: December 11 , 1987 , , j l `
(TOWN SEAL)
OFFICE OF THE TOWN CLERK `OFD
Town of Southold ®� fi �Q ' Application No.63 /
Judith T. Terry, Town Clerk ,,. s �'` Residential
Town Hall, 53095 Main Road c 4,7;
P. O. Box 1179 cr3 xO; Non-Residential
Southold, New York 11971 %t0' ` �-
Telephone ( �g
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. ‹..5'3 `
Fee $
_ DATE ( 2-/
OWNER NAME: \,r-1. fz0 ,662f S11/1 ,1 NS'(
OWNER MAILING ADDRESS: / '3 (7/ I`f//'S e
OWNER PROPERTY ADDRESS: ( 3 y f
SUu� �� tel. `/ I // S'7 /
OWNER TELEPHONE NUMBER: '2 C� r �� J
TAX MAP NO. : Section 9 Block -3 Lot 3 ')
CROSS STREET: i"\( (),e i 46-J
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: f f12c-H /7
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.)
S . LA, -
?f Signature of 'Applicant
0a
RECEIVED BY: ► - - I -•_ ,r
Town Ch rk's •ff,'e
DATE:
DEC 11 1987
Southold Town Clerk