HomeMy WebLinkAboutNorris OFFICE OF THE TOWN CLERK �fFi[�(`,O
Town of Southold 0� y
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road 'fin
P. 0. Box 1179 Ln y�
Southold, New York 11971
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 205 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool X
NAME OF OWNER: Bruce Norris
OWNER MAILING ADDRESS: Box 25 New Suffolk Avenue
i,Mattituck, New_York
OWNER PROPERTY ADDRESS: New Suffolk Avenue
Mattituck, New York
OWNER TELEPHONE NUMBER: 516-298-8349 or 8511
TAX MAP NO. : Section 115 Block g Lot 3
- CROSS STREET: Reeve Avenue
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
Judith T. Terry
Southold Town Clerk
DATE: February 3, 1987
(TOWN SEAL)
OFFICE OF THE TOWN CLERK
Town of Southold ��� Y �C�� Application No
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road a ! Residential
P. 0. -Box 1179 Ln _ Non-Residential
Southold, New York 11971
Telephone.(
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
- - -- - - - �-for-- - -- - - --- ------ - - - -
OPERATION PERMIT
SEPTIC TANK-or CESSPOOL
Operation Permit No.
Fee $ /6-
DATE / - 3 ^
OWNER NAME:
OWNER MAILING ADDRESS: ® x J �-
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER:
TAX MAP NO. : Section - Block Lot
CROSS STREET: Egg A
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ✓ New Existing t/
Residential 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.)
S gn ure of Ap licant
RECEIVED BY: c�
?`own rk's Office
-- ._
FEB 02 1987
DATE:
Town Clerk Southold
ry
1
�i
IJ6
b
S