HomeMy WebLinkAboutMoore OFFICE OF THE TOWN .CLERK .c0FgUrezG
Town of Southold
Judith T. Terry, Town ClerkI, .04�
Town Hall, 53095 Main Road ,
,
P. O. Box 1179 cnH� � f �
Southold, New York 11971 f
Telephonelit
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 349 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool X
NAME OF OWNER: David P. Moore
OWNER MAILING ADDRESS: 29895 Main Road
Orient, -New York 11957
OWNER PROPERTY ADDRESS: 29895 Main Road
Orient, New York
OWNER TELEPHONE NUMBER: 516-323-3740
TAX MAP NO. : Section 18 Block 2 Lot 36
CROSS STREET: Platt Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS. PUMP-OUT: May 1987
Judith T. Terry
Southold Town Clerk -
DATE: . July 15, 1987
(TOWN SEAL) =
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OFFICE OF THE TOWN CLERK �3�FFO ( c�
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Town of Southold �� CQ ; Application No. 7 1
Judith T. Terry, Town Clerk Y
Town Hall, 53095 Main Road uvw- Residential
P. O. Box 1179 inanom '{ . Non-Residential
Southold, New York 11971 O `
Telephone ‘'.4 �►
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE \G(GL (o /q(7
OWNER NAME: 61J L I 1 Vh-°
OWNER MAILING ADDRESS: --)-9 OS- (f 4I 9 2,
0a� e �-) M' `�._ 1 qc7
OWNER PROPERTY ADDRESS: jC
OWNER TELEPHONE NUMBER: -374o
TAX MAP NO. : Section // Block Lot (-K4
CROSS STREET: �,(�-Fj ',) '
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TYPE OF SYSTEM: Septic Tank New Existing
Cesspool l/ New Existing
Residential t7 Non-Residential
DATE OF PREVIOUS PUMP-OUT: M41,4 M(f' ?
!
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.)
iff ir •
Signa' ure of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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