HomeMy WebLinkAboutMullins OFFICE OF THE TOWN CLERK 6 •c0FOI./(e.-
Town of Southold
Judith T. Terry, Town Clerk � � • ,sem
Town Hall, 5305 Main Road c "E �� '`°
P. O. Box 1179 ‘•1-13
Southold, New York 11971 O -(-97);'''' ff ••,
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Telephone ' �
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 466 Residential x
Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: - James E. and Eve C. Mullins
OWNER MAILING ADDRESS: P.O. Box 882
Southold, New York 11971
OWNER PROPERTY ADDRESS: Sunset Lane
Southold, New York 11971 •
OWNER. TELEPHONE NUMBER: 516-765-9259
TAX MAP NO. : Section 88 Block 6 Lot 6
CROSS STREET: West Lake Drive
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: 1985
Judith T. rry
Southold Town Clerk
DATE: October 19, 1987
(TOWN SEAL)
OFFICE OF THE TOWN CLERK cVFFOU(�
Town of Southold oho CQG'_, Application No. o
Judith T. Terry, Town Clerk ` ,
Town Hall, 53095 Main Road '`. " r Residential
P. O. Box 1179 cry ice" ► Non-Residential
__
Southold, New York 11971 O I
Telephone _ 1lk ,
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE
OWNER NAME: ri-AM S E P-MrB gve. Q . rlut. LeN4.
OWNER MAILING ADDRESS: ?'. 0 ,
IIci—n
OWNER PROPERTY ADDRESS: ti1.rse-r LAw€..
Secs (N 0L9. tv.44. tk9 1
OWNER TELEPHONE NUMBER: ( 510 i C.-- q a- j
TAX MAP NO. : Section Oo• Block - Lot -
CROSS STREET: tAY ,T 1Ace O2(vQ
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential )C. 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.)
OJV'c4-o . f l i9.�Q�LLLt�
Signature of Applicant
•
RECEIVED BY:0,,,4t , -
Town C -rk's if i o'e
DATE:
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