HomeMy WebLinkAboutMills (3) _ -OFFICE OF OF THE TOWN -CLERKTown of SoutholdJudithT. Terry, Town Clerk l(0:3\\Lif
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TownHall," 53095 Main Road i' 'B f
P. 0. Box 1179 `1 nf`' tiu
Southold, New York 11971 Q ''® .'
Telephone SO c '��
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT __
SEPTIC TANK or CESSPOOL
Operation-Permit No. 401 Residential X
- Non-Residential
- -- Fee $ 10.00
Septic Cesspool X
•
- NAME OF OWNER: William H. Mills _
OWNER MAILING ADDRESS: 265 Oak Drive
Southold, New York 11971
OWNER PROPERTY ADDRESS: 265 Oak Drive
Southold, New York
OWNER TELEPHONE NUMBER: 516-765-5326
TAX MAP NO. : Section go Block i Lot 31
CROSS STREET: Reydon Drive
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ' X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: June 26, 1987 - -
- 1p..-1i+lam T. Tarry
Southold Town Clerk
DATE: August 14, 1987
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK cOFair
Town of Southold .. Application No. 2C)
Judith T. Terry, Town Clerk
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Town Hall, 53095 Main Road o :•C Residential
P. O. Box 1179 u' *�� „ ,{ Non-Residential
Southold, New York 11971 O ®
Telephone : .! ! [
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 274°
Fee $ Jo
DATE RV Ci- \o \R
OWNER NAME:
OWNER MAILING ADDRESS: 1--6 -0 F;i�- �2.\U
OWNER PROPERTY ADDRESS:
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OWNER TELEPHONE NUMBER: (cA
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TAX MAP NO. : Section C. Block / Lot 9
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool v New Existing ✓
Residential / Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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.)
ig ature of Applicant
RECEIVED g °�
kf `r Town Jerk's (fice
DATE: AUG 1 4 1987
Town Clark Southold
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