HomeMy WebLinkAboutTandy OFFICE OF THE TOWN CLERK c0FOLA-c;"
Town of Southold �y
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road
P. 0. Box 1179 \ cn
Southold, New York 11971
Telephone ji
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
. SEPTIC TANK or CESSPOOL
•
Operation Permit No. 278 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool X
NAME OF OWNER: John A. Tandy —
OWNER MAILING ADDRESS: Box 788
Mattituck, New York 11952
OWNER PROPERTY ADDRESS: 1900 Pike Street
Mattituck, New York
OWNER TELEPHONE NUMBER: 516-298-8611
TAX MAP NO. : Section 140 Block 3 Lot 71
CROSS STREET: Maple Street
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Never
�eter--�..��
Judith T. Terry
Southold Town Cler
DATE: April 14, 1987
(TOWN SEAL)
IA.
OFFICE OF THE TOWN CLERK -COO/Jr
Town of Southold �� CQ Application No. 7%f��
Judith T. Terry, Town Clerk &
53095 Main Road ;s;� Residential
Town Hall, � ;.�
P. O. Box 1179 y ` tri `' Non-Residential
New York 11971
Southold, o �0�,��
Telephone .� 1‘
'1
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
' SEPTIC TANK or CESSPOOL
Operation Permit No. , 76
Fee $ Jo
DATE `-'S °`'-S -7
OWNER NAME: / / Al ?' f fl jJ]`7
OWNER MAILING ADDRESS: -RD c7 -8- /14975 v -Z /IQ.5-2_
1g00
OWNER PROPERTY ADDRESS: Jed l< S N A f
OWNER TELEPHONE NUMBER: a 9S' ^F5-6/f
TAX MAP NO. : Section f I b Block 3 Lot ,2,/
CROSS STREET: ,sTAL
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool q/ New Existing
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.)
Signature of Applicant
RECEIVED BY: C - .e
RECEIVED-rown ? k's Of ice
DATE: App !QR7
Town Clerk Southold