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OFFICE OF THE TOWN CLERK ' icAFOU(r;
Town of Southold �ty
Judith T. Terry, Town Clerk % 1- 41� �`
Town Hall, 53095 Main Road
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P. O. Box 1179 ® •���
Southold, New York 11971 , O O., „Y ��-
Telephone ,. 1
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 358 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool,` X
NAME OF OWNER: J. Furman & Minnie M. Neefus
OWNER MAILING ADDRESS: P.O. Box 505
Southold, N.Y. 11971
OWNER PROPERTY ADDRESS: Same
OWNER TELEPHONE NUMBER: (516) 765-2593
TAX MAP NO. : Section 81 Block 3 Lot 15.2
CROSS STREET: Robinson Road
TYPE OF SYSTEM: Septic Tank New Existing X
Cesspool New Existing X
Residential X - Non-Residential
DATE OF PREVIOUS PUMP-OUT: May 28, 1987
Judith T. ,Terr
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Southold Town Clerk
DATE: July 23, 1987
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK �cwFF7(,1 - e`=
Town of Southold ��� CQG'- Application No. :i,'
Judith T. Terry, Town Clerk i ',..0 e.
Town Hall, 53095 Main Road c, �"`' Residential
P. O. Box 1179 u3 `°� :' Non-Residential --
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Southold, New York 11971 ® �Iffn ; • -
Telephone' -4 �l ;'
(516) 765-1801 -
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
- for -
OPERATION PERMIT' _\ '
SEPTIC TANK or CESSPOOL '
Operation Permit No. L -
Fee $ / ,, a ',0 -
DATE �. e �p
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OWNER NAME: 07‘ i1444 • 0
OWNER MAILI G ADDRESS: p, p'. • 6 en/ 5"-epro.
. ttl'euw-goide, 9-#: /-/ r i7
OWNER PROPERTY ADDRESS:
44t004.046. .*r
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OWNER TELEPHONE NUMBER: Plym in 5.s 513
TAX MAP NO. : Section r, Block 2 1 Lot . / '-"d. '`Z..
CROSS STREET: ',0„ "erveadg4 ' --
of?frie
TYPE OF SYSTEM: Septic Tank New Existing 1.0014
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Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: / 7 2 /
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.)
Signature of Apr'icant f
RECEIVED BY: �,`/ A '‘ ,��
0 n Clerk s • fice -
DATE: 7/020A-7-7
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