HomeMy WebLinkAboutTaylor (4) •
OFFICE OF THE TOWN CLERK ' c0FU(t
Town of Southold CSG
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road •
P. O. Box 1179 v' r
Southold, New -York 11971 ;4 ,
Telephone -AO
t �►�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 61 Residential XX
Non-Residential
Fee $ 10.00
Septic Cesspool XX
NAME OF OWNER: George H. Taylor
OWNER MAILING ADDRESS: 1645 Westphalia Road
Mattituck, New York 11952
=OWNER PROPERTY_AD.DRESS: --1-645---Westphalia_Road
Mattituck, New York
OWNER TELEPHONE NUMBER: 516-298-4850
TAX MAP NO. : Section 141 Block 1 Lot 6
CROSS STREET: Horton Avenue
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool XX New Existing XX
Residential XX Non-Residential
DATE OF PREVIOUS PUMP-OUT: 1955
Judith T. Terry
Southold Town Clerk
DATE: September 23, 1986
" (TOWN SEAL)
J, - - -
•
OFFICE OF THE TOWN CLERK �CI\TF
Town of Southold CS
_ G Application No. /
� 4 1
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road c Residential
.
P. O. Box 1179 cn � � Non-Residential
Southold, New York 11971
Telephone
�1� ��� '
(516) .765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. (,
Fee $
G
/((5-
DATE
OWNER NAME: L1 l4 # 2L,hrx/
OWNER MAILING ADDRESS: /45/6' fQ
Zvi 0,.- / -74y /l�s
- - OWNER PROPERTY ADDRESS: itJ,2d ,-H-r t�{�Q,; - -
(J
OWNER TELEPHONE NUMBER: 92- 17471'S.6Q17471'S.6
314* Cv, 7"0'c ' / o c p /`f/
TAX MAP NO. : Section Block Lot
CROSS STREET: T-6-4-11-1,,,
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential U Non-Residential
DATE OF PREVIOUS PUMP-OUT: /9"515
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.)
•
4
Signature of( pplican
RECEIVED BY: �� 6_7
Town(,Clerk's Office
DATE: oite�ry�f e3.2 3, /9-
d
U • 1 a
worrigh From the desk of
NI:1000 GEORGE H. TAYLOR / i -
eLL
•
!N
of 0
N
�j'
71-1