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OFFICE OF THE TOWN CLERK 6F0
Town of Southold ���� . C�
Judith T. Terry, Town Clerk � � t°
46,
Town Hall, 53095 Main Road
P. O. Box 1179 `� .` .: �� .
Southold, New York 11971 Q O .Y, . �0 •
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER JDISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 232 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool X
NAME OF OWNER: Stanley Mickaliger
OWNER MAILING ADDRESS: Box 993, Sigsbee Road
Mattituck, New York 11952
OWNER PROPERTY ADDRESS: Sigsbee Road
Mattituck, New York
OWNER TELEPHONE NUMBER: 516-298-4977
TAX MAP NO. : Section 143 Block 2 Lot 15
CROSS STREET: Main Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
- -- DATE OF PREVIOUS PUMP-OUT: November 4, 1986
Judith T. Ter
Southold Town Clerk
DATE: March 5, 1987
(TOWN SEAL) ''f,
c ..
OFFICE OF THE TOWN CLERK 0FOUr 073
Town of Southold �Q CQ '; Application No.
Judith T. Terry, Town Clerk �►� al ^/
t, x
Town Hall, 53095 Main Roadz -
� l Residential
P. O. Box 1179 uz ;+ ;' Non-Residential
Southold, New York 11971 O ��`
Telephone :�.( * 't .09
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
'SEPTIC TANK or CESSPOOL
Operation Permit No.02,3
Fee $ /0 . 00
DATE nic-VICArit
OWNER NAME: St-a l° I rvi ► 347
OWNER MAILING ADDRESS: 80 X Q 9 ; ; r 3 6e e_ krq
OWNER PROPERTY ADDRESS: , / q S
OWNER TELEPHONE NUMBER: ...5-76
TAX MAP NO. : Section Block Lot / L/3 - _ / 5�
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: ///y/ ?-6.
J' Lf/ ?-6
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.)
Sig ature g Appli t
RECEIVED B Y: p{ _ct,c,Q, j)
Recevi wn lerk's Office
DATE:
�A�' 1997
MAR .�
down Meek Southold