HomeMy WebLinkAboutThompson OFFICE OF THE TOWNCLERK 4 c31FUCKcO
Town of Southold y
Judith T. Terry, Town Clerk ` 1,4VAN
Town Hall, 53095 Main Road i14"
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P. O. Box 1179 *-5
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Southold, New York 11.971 - `Telephone i'770/
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 429 Residential X
Non-Residential
Fee $ 10.00 Septic Cesspool X
NAME OF OWNER: Lucy G. Thompson
OWNER MAILING ADDRESS: Box -833
Orient, New York 11957
OWNER PROPERTY ADDRESS: Main Road
Orient, New York
OWNER TELEPHONE NUMBER: 516-323-2485
TAX MAP NO. : Section 17 " Block 1 Lot 11.6
CROSS STREET: Corner of Main Road and Old Main Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: 7-10-87
•
T Terry ,
Southold Town Clerk
DATE: September 18, 1987
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(TOWN SEAL)
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OFFICE OF THE TOWN CLERK FOCA-O.CO '
Town of Southold
0�� Application No/7/02-'7Judith T. Terry, Town Clerk , ._`
Town Hall, 53095 Main Road -'� Residential
a ^ x -
P. O. Box 1179 (-n „ . Non-Residential
Southold, New York 11971 O �•� `
Telephone _ 1 00, •
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
;or -
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /0
DATE 0 / 3- '4)
OWNER NAME: Lc G • IL L &6 4-0
OWNER MAILING ADDRESS: 6o1., e 3
Ors` eP o/. / l967
OWNER PROPERTY ADDRESS: C1)4 ; a
C/r i e / !/ _ (if if 9 3 7
OWNER TELEPHONE NUMBER: 5/Z 3 7 3 - j i4s'
TAX MAP NO. : Section J`1 Block 1 Lot A)
CROSS STREET: �, � �� c1 J JJ
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool -& New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: 7- /� ,' 7
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.)
Sinure of Appli nt
RECEIVED BY: O
RECtIVIwn Jerk's ffice
DATE: SEP 171997
Town Cork Southold
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CERTIFIED TO - MAIN ROAD ( S. R. 25 )
CHARLES W. THOMPSON
SURVEY OF PROPERTY
AT
ORIENT
TOWN OF SOUTHOLD
SUFFOLK COUNTY, N. Y.
1000 - 017 - 01 - ,1-er //. (o
SCALE I = 40'
/ ANb &; %\\� MAY 7 , 1987
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, __ _____ .#J N .Y. S . LIC. NO. 49668
Prepared in accordance with the minimum
PEC OP Wilk r YORS a ENGINEERS , P. C ,
( 516) . 5 0 2 0 standards for Ole ®s bushed bq
the L.9.A.0,.S. and •ip�eved axed adoptee
P. O. BOX 909 for such me by New York State Land
MAIN ROAD Title Association.
SOUTHOLD , N .Y. 11971
87 — 337