HomeMy WebLinkAboutThibaut OFFICE OF THE TOWN CLERK • cOFDU(`,
Town of Southold rs-
Judith T. Terry, Town Clerk � R
Town Hall, 53095 Main Road c .. S i
P. O. Box 1179 '�
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Southold, New York 11971
Telephone
(516) 765-1801 - n
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation- Permit No. 540 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: Elizabeth Thibaut
OWNER MAILING ADDRESS: Ruch Lane
Southold, New York 11971
OWNER PROPERTY ADDRESS: Ruch Lane
Southold, New York 11971
OWNER TELEPHONE NUMBER: 516-765-5732
TAX MAP NO. : Section 52 Block 2 Lot 23
CROSS STREET: Route 48
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
orevialeuvor..,
Judith T. Or.rry
Southold Town Clerk
DATE: December •15, 1987
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK C��FFD(,rpf,
Town of Southold �� CQG Application No. Ur/v
Judith T. Terry, Town Clerk , 41. ~�' �',
Town Hall 53095 Main Road _ :, -.4 I Residential
Gas s + .
P. O. Box 1179 v' 4- Non-Residential
Southold, New York 11971 Off® _: �•,.,.
Telephone _
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /0 ,o
DATE a% /0 ,907
OWNER NAME: ,//2 61 /3 / rt L%i
OWNER MAILING ADDRESS: /? YC 6/
®U 7/(10-(/1J Gl, r/?V
OWNER PROPERTY ADDRESS: �' 771 dd
OWNER TELEPHONE NUMBER: n 5--
TAX
-TAX MAP NO. : Section 5— 2,-23 23 Block Lot
CROSS STREET: /?d a '! g
TYPE OF SYSTEM: Septic TankS v New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: ±aV � KAJtja_)--
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.)
ignature of Applicant
•
RECEIVED BY: iyt..cGw
R CENEMiiown C rk's Off c� e
DATE: DEC 1 5 1987
Twin rt$rk Southold
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