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HomeMy WebLinkAboutThompson (2) OFFICE OF THE TOWN CLERK ' Ic0FOUre" Town of Southold ,y... Judith T. Terry, Town Clerk 4 *1' Town Hall, 53095 Main Road P. 0. Box 1179 - ® ' `. Southold, New York 11971 _ •�, Telephone _ 1i (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 211 Residential x Non-Residential Fee $ 10.00 Septic. Cesspool x NAME OF OWNER: Robert Thompson OWNER MAILING ADDRESS: P.O. Box 309 Southold. New Yn rk 11971 OWNER PROPERTY ADDRESS: 3600 South Harbor Road Southold, New York OWNER TELEPHONE NUMBER: 516-765-3030 TAX MAP NO. : Section 75 Block R Lot 3. 1 CROSS STREET: Hiawatha Path TYPE OF SYSTEM: Septic Tank New Existing Cesspool X New Existing X Residential X. Non-Residential DATE OF PREVIOUS PUMP-OUT: June 3, 1981 • Judith T. Terr Southold Town Clerk DATE: February 3, 1987 (TOWN SEAL) OFFICE OF THE TOWN CLERK oc0FO(,(4C� Town of Southold Application No. Judith T. Terry, Town Clerk . r.- Via, •�. � 1 Town Hall 53095 Main Road ' Residential P. O. Box 1179 cn :' Non-Residential Southold, 'New York 11971 O O�•�` Telephone nr �►�• .' (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT • SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ da e,frti /17/i-gt DATE OWNER NAME: �� / � 1��I Soli/ OWNER MAILING ADDRESS: P©, !J 41) Sri u_`77 4 d `f - // 9 7 OWNER PROPERTY ADDRESS: A4®D moo, #ii- jL ' fd S ,. �d /1 97i OWNER TELEPHONE NUMBER: 7 5-- 3 3 TAX MAP NO. : Section �� Block g Lot Io CROSS STREET /11f9 oi-210 Q PSS TYPE OF SYSTEM: Septic Tank New Existing Cesspool 71, New Existing Residential >4, Non-Residential DATE OF PREVIOUS PUMP-OUT: 1p - — I 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.) f// •ignature of i.plicant RECEIVED BY: Town Clerk's Office RECEIVED DATE: FEB 0-137 Town Clerk Southold N fi b-e,g lr 1 U b wt-16 -6) iv so , 1-1 ,?2/,--&l // 97/ o„r vd/- o 1\.6/ NI e/ - r# b6 / qf S0 , izpC12 12t_