HomeMy WebLinkAboutMilne OFFICE OF THE TOWN CLERK 'cO -UU(N
Town of Southold
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road
P. O. Box 1179r $' �,'
Southold, New York 11971 Q ,,;"� . sr •
Telephone _�1
(516) 765-1801 if
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation. Permit No. 557 Residential X
Non-Residential
Fee $ 10.00 Septic Cesspool X
NAME OF OWNER: Ralph Milne
OWNER MAILING ADDRESS: Box 294, Knoll Circle
East Marion, New York 11939
OWNER PROPERTY ADDRESS: Knoll Circle, Gardiners Ray FstatPs
East Marion, New York
OWNER TELEPHONE NUMBER: 516-477-0708
TAX, MAP NO. : Section 37 Block Lot 15
CROSS STREET: Bayview Drive
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown .
•
Southold Town lerk
DATE: January 4, .1988
(TOWN SEAL)
OFFICE OF THE TOWN CLERK ,C��F�a(/l'P7=
o Town of=Southold *44:-- - (W.. Application Noss'
Judith T:,,.Terry, Town (Clerk % /
• (3 air :4 1 Residential
Town Hall, 53095 Main Road
P:.-O. Box 1179 5110i M Non-Residential
Southold, New York 11971 s
0-0
Telephone _Yl` t ��
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ III
00
DATE j/y FEr -
OWNER NAME: 0 ,%21
OWNER MAILING ADDRESS: Kfr A/0174z E / JV. JJ.AV/ ii,
OWNER PROPERTY ADDRESS-: j - % - j� /$y £
OWNER TELEPHONE NUMBER: ,77 - D701
TAX MAP NO. : Section a 7 Block .�-- Lot / ---
CROSS STREET: r
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool V New Existing
Residential V Non-Residential
DATE OF PREVIOUS PUMP-OUT: / 1/ 4i-ei /7/7
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.)
to,S gnature of Applicant
t ARECEIVED BY: / %, Allit/..e,A -
To n Cl-rk s •ffice
DATE:
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