HomeMy WebLinkAboutOlsen (3) OFFICE OF THE TOWN CLERK
Town of Southold �
Judith T. Terry, Town Clerk i ..r ,
Town Hall, 53095 Main Road 8 , -
P. 0. Box 1179 � *
Southold, New York 11971 p '52;;'r %r.
Telephone �l1411
1516) 765-1801 -
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 593 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: Janice M. Olsen
• OWNER MAILING ADDRESS: P.O. Box 614
Riverhead, New York 11901
OWNER PROPERTY ADDRESS: Reeve Road
Mattituck, New York
OWNER TELEPHONE NUMBER: 516-298-9312
TAX MAP NO. : Section 100 Block 1 Lot 10
CROSS STREET: Wavecrest- Lane
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool x New X Existing
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: New
Judith T. erry
Southold Town Clerk
DATE: February 10, 1988
_(TOWN SEAL)
II AlIo
OFFICE OF THE TOWN CLERK 8COFt)(,r�'=
Town of Southold �% 6 - eon' Application No..5
'
Judith T. Terry, Town Clerk .r ,
�r � z Residential
Town Hall, 53095 Main Road .
P. O. Box 1179 cn k« 4� �i Non-Residential
Southold, New York 11971 4 ;�}� 0
Telephone 4 Y► '
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
_ APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. `j p
Fee $ Ftj , I
DATE (9-7/// z(
OWNER NAME: \TIM / e 1Y)i. oJEA
OWNER MAILING ADDRESS: "P 0 k7 ox le )9
7 v l`Hl= /0 11 ct0 (
OWNER PROPERTY ADDRESS: 7EV.E OD ,
OWNER TELEPHONE NUMBER: (-(- 576 - 2.9�- q 3 /2-
,
TAX MAP NO. : Section / CYO Block 1 Lot /6
CROSS STREET: w }VEc) S't' 2- J9-1/5
TYPE OF SYSTEM: Septic Tank tb,W New d>Jdr Existing
Cesspool t, New Existing
Residential tom' 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, appro imately, to building and closest road.)
See Cbz r ;ok) p 'rwN
Signature of Applicant
l
RECEIVED BY: IDI //
own ile• s I fice
DATE: //'E