HomeMy WebLinkAboutMills OFFICE OF THE TOWN CLERK c,5\001_,t4r
Town of Southold
':',7:11}
Judith T. Terry, Town Clerk is �'
,�,.,
Town Hall, 53095 Main Road , ��.,=��a°
P. 0. Box 1179 ' U'' 1i
Southold, New York 11971 _^
Telephone ,740/ 110
(516) 765-1801
0
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 542 Residential X
Fee $ 10.00 Non-Residential •
Septic Cesspool X
NAME OF OWNER: Mary E. Mills
OWNER MAILING ADDRESS: 265 Factory Avenue
Mattituck, New YOrk 11952
OWNER PROPERTY ADDRESS: 265 Factory Avenue
Mattituck, New York 11952
OWNER TELEPHONE NUMBER: 516-298-8755
TAX MAP NO. : Section 122 Block 6 Lot 7
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: 1984
Judith T. i rry •
Southold Town Clerk
DATE: December 16, 1987
(TOWN SEAL)
OFFICE OF THE TOWN CLERK iOH
Town of Southold ®� �Q Application
Judith T. Terry, Town Clerk
..o„
Town Hall, 53095 Main Road j ' :G 7 Residential
P. O. Box 1179 cal "ft
" ".' Non-Residential
Southold, New York 11971 ® kms J• •
Telephone = sg
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ , 0U
DATE ? 1 ) Ig'?
OWNER NAME: ! v► A E. AA 1)3 •
OWNER MAILING ADDRESS: / PQ 1 p ( v e
a--
OWNER
—OWNER PROPERTY ADDRESS: 6 ce_vrl _
OWNER TELEPHONE NUMBER: oa [ S'75 j
TAX MAP NO. : Section ! JD_ Block ,C Lot 7
CROSS STREET: mict4 N IQ Del,
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: , OcOkl-
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.)
FretthoSi nat e of Applicant
A
RECEIVED BY: C ,- / .
• n Cr-rk's O 'fice
DATE: 49//X/c
/ .e
`/ 1, �'`max -/" \ -
ilk'\\ i ' ./...".- ...,' \, „7. 1
i J J-
1, �, .(1-1
7 5� �P t, M
4 r'j 4'.J
-' c . Z "?1 rt, r--t i .. ,
rr
t\ ' 4.
„ Ch
hrar� l ,
ks
•
to f"...,..(j✓1.� i r� . `7y ,
D / , ,5 Ali ,'i. `, v< 4. -
/ 1 ` c ratYL V-6,1 W
` _ �. __I_--- -
1.' �' r LF Y� C�11 15,
.' .� :. -- .�. _ ', - '
el,A _,.......a.,„.,-1. Sol. ' kt,‘ 1
i
_ t" t-; pl ,...•-•, .`
, ' , A , , IN i
r5Q
!/ t '; ` f :r3 5�, s lam.
�•-A 0 •y- (b ,` is P, ( f?,I' cl.: . 1
1 •
1 ,.,r- .-..,: _ v E,,..,moi 4,,,i (l'. t - • "� - -yYFi�,````5� As-
- E 3 , 4-,,, i E} ;.�-
•
3+ d �- .-
{_
t . ., _ . ,-v:A.. 1, --" ' .
I
, l ,1J- I ° `I..,