HomeMy WebLinkAboutTeter OFFICE OF THE TOWN CLERK ' COMA'
Town
Town of Southold
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road : ,
P. O. Box 1179 cn F`•
Southold, New York 11971
Telephone _ � * l�O
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 6 Residential
XXX
Non-Residential
Fee $ 10. 00 '
Septic Cesspool XXX
- NAME OF OWNER: Elizabeth S . Teter
OWNER MAILING ADDRESS: P .O . Box 517
Laurel , New York 11948
OWNER PROPERTY ADDRESS: 490 Peconic Bay Blvd .
Laurel, New York 11948
OWNER TELEPHONE NUMBER: 298-8513
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TAX MAP NO. : Section 145 Block 2 Lot 5
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CROSS STREET: Laurel Lane & Laurelwood Drive
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool XXX New Existing XXX
Residential xxX Non-Residential
DATE OF PREVIOUS PUMP-OUT: 8/3/84
Judith T. Terry
Southold Town Clerk
DATE: August 15 , 1986
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK ��FD(K
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Town of Southold �� CQApplication No.
Judith T. Terry, Town Clerk �`, y
Town Hall, 53095 Main Road `- - : . Residential
P. O. Box 1179 ' cn Non-Residential
Southold, New York 11971O O�r•�`�
Telephone = ( �
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
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OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. C
Fee $ /D,00
DATEt ,30, 1914
OWNER NAME: eLejoe+-it, —7T-te,r
OWNER MAILING ADDRESS: PO . /50X 4'17
1v4a re,l• Al I F`fr
OWNER PROPERTY ADDRESS: 1490
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OWNER TELEPHONE NUMBER: sit) ,?5g- j513
TAX MAP NO. : Section /e5f, - Block 0 Lot ,5
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CROSS STREET: `` &pre( Lahr t hfesr - +o 4',Ce Fal.
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TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ✓ New ✓ Existing ✓
Residential / Non-Residential
DATE OF PREVIOUS PUMP-OUT: FI3iar, 1" 1
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.)
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Signature of Applicant
RECEIVED BY: C , /� / _,_//
fCI-rk's office 6 •
DATE: F /
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