HomeMy WebLinkAboutNeese OFFICE OF THE TOWN CLERK • ecgfO[i( ,OG
Town of Southold
Judith T. Terry, Town Clerk Z ." �
Town Hall, 53095 Main Road c
P. O. Box 1179 ,514;374.'
Southold, New York 11971 b ® ‘ •�
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 328 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool X
NAME OF OWNER: Chester L.Neese
OWNER MAILING ADDRESS: Box 126
Southold, New York 11971
OWNER PROPERTY ADDRESS: 1625 O'aklawn Avenue
Southold, New York
OWNER TELEPHONE NUMBER: 516-765-3725
TAX MAP NO. : Section 70 Block 3 Lot 6
CROSS STREET: Jernick Lane
TYPE OF SYSTEM: _Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: 1983
Judith T. Terry
Southold Town Clerk -
DATE: July 14, 1987
(TOWN SEAL)
OFFICE OF THE TOWN CLERK cOFOUr��=
Town of Southold �® ,-- •• eQG' Application No.4-D9(::2
Judith T. Terry, Town Clerk y
Town Hall, 53095 Main Road ` -C`� Residential
P. O. Box 1179 �' ''>rr ` ,• Non-Residential
Southold, New York 11971 `" F" �$`
Telephone : ' • I
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3a-7
Fee $ /6
DATE 7 J/ff7
OWNER NAME: e Alk-E,5-&--
OWNER
Vk-E,5-&OWNER MAILING ADDRESS: 76 x /2 6.
�S®urs®4,N. y /i971
OWNER PROPERTY ADDRESS: /6,71,5-- eA./<L,gi J/ AY
SO- 7- 4L.J,/V. t,
OWNER TELEPHONE NUMBER: 6-/g - 75"
TAX MAP NO. : Section 7() Block 3 Lot 6
CROSS STREET: �ieA//c'k Z. 14-4/ ,X,
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing )(
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: ,f 3
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 Applica
RECEIVED BY:
Town Clerk's Office
DATE:
iT RA// Cike 4157.
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