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OFFICE OF THE TOW CLERK cAF01XC'
Town of Southold/2' � cG
Judith T. Terry, Town'Clerk Z ?55
Town Hall, 53095 Main;Road c � .'M
P. O. Box 1179; •� s '
Southold, New York '11971
Telephone i
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation_ Permit No. '586 Residential x
Non-Residential
Fee $ 10.00
Septic Cesspool X =
NAME OF OWNER: Raymond F. Nine
OWNER MAILING ADDRESS: P.O. Box 1401
Mattituck, New York 11952
OWNER PROPERTY ADDRESS: New Suffolk Avenue
Mattituck, New York
OWNER TELEPHONE NUMBER: 516-298-8828
TAX MAP NO. : Section 114 Block 11 Lot 22.1
CROSS STREET: Main Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
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Judith T. Terry
Southold Town Clerk
DATE: January 27, 1988
(TOWN SEAL)
OFFICE OF THE TOWN-CLARK COFO(,r
Town of Southold Oho 41 -- Application No. 02-e&Judith T. Terry, Town Clerk . '
Town Hall, 53095 Main Road ,)1,- " , :'L 1 Residential
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P. O. Box 1179 _ �,t.� vp" ��, Non-Residential
Southold, New York 11971 O ®x ' ao*•'�
Telephone fid %� ;$1
(516) 765-1801 '
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. jig,
Fee $ /O °---
DATE /141.44/4/1_21/79",
OWNER NAME: 27/igf /Aft /7 71,&I
OWNER MAILING ADDRE S: ft e JR IJ f ( t,
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OWNER PROPERTY ADDRESS: ) RA
OWNER TELEPHONE NUMBER: C/6^ 2- q/- ?/9F
TAX MAP NO. : Section f/G Block /1 Lot7P„, /
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
1-,/
Cesspool ew Existing
Residential Non-Residential
- DATE OF PREVIOUS PUMP-OUT: fc,1144
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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.)
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Pg 1 Ire to ``-'"pp is- 't
RECEIVED BY: a
Town rk's Of ice
DATE: JAN 26101
a'
Trnwn Clerk Southold
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