HomeMy WebLinkAboutTerp (2) OFFICE OF THE TOWN CLERK '6 c0F0l'
Town of Southold � �� •
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road o . t'r
P. 0. Box 1179 • 1%v'
Southold, New York 11971 - ;tz'' �- •
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Telephone - =0./ .„,%‘
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation_ Permit No. 592 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool X
NAME OF OWNER: Joseph J. Terp
OWNER MAILING ADDRESS: Box 287
Southold, New York 11971
OWNER PROPERTY ADDRESS: Mailer Court
Southold, New York 11971
OWNER TELEPHONE NUMBER: 516-765-9265
TAX MAP NO. : Section 70 Block g Lot 33
CROSS STREET: Custer Avenue
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: 1985
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Southold Tow Clerk
DATE: January 29, 1988 _
(TOWN SEAL)
T • ii.
OFFICE OF THE TOWN CLERK COFOC,r�."
Town of Southold L'D Application No. 6-90)----"
Judith T. Terry, Town Clerk . G •,
Town Hall, 53095 Main Road tom. x` �, ) Residential
P. O. Box 1179 cn t£ �:' Non-Residential
Southold, New York 11971 ‘t•-
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Telephone _ j
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ !b r
DATE
OWNER NAME: �J 0,5 4/ , „,,®
OWNER MAILING ADDRESS: 134x0$/7 /f,41tw. c7'
OWNER PROPERTY ADDRESS: ,Si��� 45 fa®s&
OWNER TELEPHONE NUMBER:
TAX MAP NO. : Section 70 Block q Lot\`
CROSS STREET: C',/4
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ✓ New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: /9$.S�
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.)
4111"-
411111V
111"-�. ✓ _ _�_tet
'ignae of Ap,•plican'
RECEIVED BY:
Town Clerk's Office
DATE:
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