HomeMy WebLinkAboutOrient Congregational Church OFFICE OF THE TOWN CLERK F�
Town of Southold ��
%Judith T. Terry, Town Clerk % si
Town Hall 53095 Main Road ~
P. O. Box 1179 :641-
Southold,
`Southold, New York 11971 `"p ® Nlyo��
Telephone �l
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 355 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool X
NAME OF OWNER: Orient Congregational Church ( Parsonage )
OWNER MAILING ADDRESS: Main Road
Orient, New York 11957 •
OWNER PROPERTY ADDRESS: Main Road
Orient, New YOrk
OWNER TELEPHONE NUMBER: 516-323-2665
TAX MAP NO. : Section )18 Block 2 Lot 22.1
CROSS STREET: Village Lane
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: . July •15, 1987 - •
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK 50F01,j- _ SSS
Town of Southold �� tr- �Q�',, Application No.
3
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road � , :' Residential
P. O. Box 1179 C°' ¢, ' Non-Residential
Southold, New York 11971 ® ®
Telephone : .( P
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE 3UL\( , 19 s1
141., ,b4.
OWNER NAME: a 'EMT Cb1C4EcAmioNtetL ril-RSol‘faC,e)
OWNER MAILING ADDRESS: DPI ENT CoNGPECV ri0tvA-L C 4-u ("ec H
dti) 1/A kvA-i , o(c'i Er'l,i� iv.y. ( \9 S 1
OWNER PROPERTY ADDRESS: S ►'-F nl ia
OWNER TELEPHONE NUMBER: 302-3 - 0% (e
TAX MAP NO. : Section Block Lot
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential v Non-Residential
DATE OF PREVIOUS PUMP-OUT: 1,.(11,k,j,,,„,1A
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.)
•
Signatureot Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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