HomeMy WebLinkAboutMott OFFICE OF THE TOWN CLERK Feur
Town of Southold ���� C�G
Judith T. Terry, Town Clerk ��
Town Hall, 53095 Main Road
3des.
P. O. Box 1179 ; '' a3,
Southold, New York 11971 `� ® "
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Telephone Ait 'W '
(516) 765-1801 -
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 84 Residential XX
Non-Residential
Fee $ 10.00
Septic Cesspool XX
NAME OF OWNER: James and Matilda Mott
OWNER MAILING ADDRESS: 42205 CountyRoad 48
Southold, New York 11971 .
OWNER PROPERTY ADDRESS: 42205 County Road 48
Southold, New York
OWNER TELEPHONE NUMBER: 516-765-1671
TAX MAP NO. : Section 59 Block 3 Lot 25.1
CROSS STREET: Tuckers Lane
TYPE OF SYSTEM: Septic Tank XX New Existing XX
Cesspool XX New Existing XX
Residential XX Non-Residential
DATE OF PREVIOUS PUMP-OUT: Jb'ne 27, 1986
Judith T. Terr�l
Southold Town Clerk
DATE: October 8, 1986
((TOWN SEAL) -
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OFFICE OF THE TOWN CLERK c3VFFOCA- c
Town of Southold Ooh{k ;F„ 1'��'t` Application No. O
Judith T. Terry, Town Clerk t .
rr ^;� .G
Town Hall, 53095 Main Road g �� � . Residential
P. O. Box 1179 Ena � Non-Residential
Southold, New York 11971
t' •
Telephone 0,( `� i'�
(516) 765-1801
TOWN OF SOUTHOLD
RECEIVED SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OCT 05 1MMM
APPLICATION
Ton Cterk Southold
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. /
Fee
$
DATE
OWNER NAME: ---,I �i% S' Qr / & / g We?
7.-7--
OWNER MAILING ADDRESS: Cle& 7..1 �G/,� -442263
S'a s.? 9/v9
_OWNER PROPERTY ADDRESS:
OWNER TELEPHO E NUMBER: L.5-7i 715 /‘7/
TAX MAP NO. : Section „..5-9 Block ,3 Lot
CROSS STREET: NIO/ 11-/ Witsige.e/ e',�r,7s .24 i'
TYPE OF SYSTEM: Septic Tank x New Existing
Cesspool New Existing •C
Residential JY Non-Residential
DATE OF PREVIOUS PUMP-OUT: -----(1)4/ 7 /,9
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.)
Com • G%ll
ignature of Applicant
RECEIVED BY: 61� , �
Townrk's Office
DATE: je_t/9..-64_e t) f 72. P
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