HomeMy WebLinkAboutTerry (3) OFFICE OF THE TOWN CLERK • cOF�(I�`+D
Town of Southold h Gy
Judith T. Terry, Town Clerk •
Town Hall, 53095 Main Road f'
P. 0. Box 1179 T
Southold, New York 11971 \ s,, .a0
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Telephone 1 11/4
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 382 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool X
NAME OF OWNER: Mooreen F. Terry
OWNER MAILING ADDRESS: Box 771
Orient, New York 11957
OWNER PROPERTY ADDRESS: 1780 Village Lane
Orient, New York
OWNER TELEPHONE NUMBER: 516-323-2454
TAX MAP NO. : Section 24 Block 2 Lot 19
CROSS STREET: Fletcher Street
TYPE OF SYSTEM: Septic Tank New Existing •
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: April 21, 1986
e re•e ,
Judith T. Terry
Southold Town Clerk
DATE: August 3, 1987
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK c�v�FP(��'=
Town of Southold ��® COG Application No.-30a
Judith T. Terry, Town Clerk . �` '4
Town Mall, 53095 Main Road ` Residential t/
` f
P. O. Box 1179 � z Non-Residential
So _
uthold, New York 11971 c:3 1_�o��►`
Telephone
_ 1
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. $'
Fee $ /d
E DATE 7/6/,
OWNER NAME: The90,Q-67 /t/
OWNER MAILING ADDRESS: 4 -2 .2 /
e Ay 1/95;
OWNER -PROPERTY ADDRESS: /7, a, //
®e/Ciu/ , Ivy /l�`✓��
OWNER TELEPHONE NUMBER:
TAX MAP NO. : Section g_ Block - Lot --/9
CROSS STREET: //� i
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool 1.7 New Existing
Residential V Non-Residential
DATE OF PREVIOUS PUMP-OUT: t —C%?/- gX
LOCATION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow and feet
of distance, approximately, toa- R building and closest road.)
Signature of Applicant
• RECEIVED BY: ,ei - . ;'
...<9.14),LAJ
mew§-own Clf k's Offfce
DATE: NJL 031987
Town Clerk Southold
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