HomeMy WebLinkAboutTimpson OFFICE OF THE TOWN CLERK ' G��FQ(iiCOG
Town of Southold ��J
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road c =r �.�� ''
P. O. Box 1179 � +� y � _
Southold, New York 11971 ;O� ®."' + /
Telephone -- ( )0"..
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT •
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 43 Residential XX
Non-Residential
Fee $ 10.00
Septic Cesspool XX
NAME OF OWNER: John E. Timpson
OWNER MAILING ADDRESS: RD 1, Box 102A, 5475 Bay Avenue
Cutchogue, New York 11935
OWNER PROPERTY ADDRESS: 5475 Bay Avenue
Cutchogue, New York 11935
OWNER TELEPHONE NUMBER: 516-734-6478
TAX MAP NO. : Section 138 Block 2 Lot 8
CROSS STREET: Pine Tree' Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool XX New Existing xx
Residential xx Non-Residential
DATE OF PREVIOUS PUMP-OUT: 1986
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Judith T. Teri
Southold Town Clerk
DATE: September 11, 1986
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK COWo'� 41,__.?Town of Southold �� - CQ ',. Application No.
Judith T. Terry, Town Clerk
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Town Hall, 53095 Main Road o11/4. Residential �
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P. O. Box 1179 u' � `r` ' . Non-Residential
Southold, New York 11971 ' �',`
Telephone
4141;0 �9
:
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 443
Fee $ OP>
DATE
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OWNER NAME: j� /1 I)/ 7---
OWNER MAILING ADDRESS: A U 15)ca/ 16c2tv-iM
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OWNER PROPERTY ADDRESS: SAM
OWNER TELEPHONE NUMBER: 7„3 4L ' I i( 7
Age c
TAX MAP NO. : /ction r %-1 ,Block 9' Lot /429
CROSS STREET: ,
TYPE OF SYSTEM: Septic Tank Y&S New Existing "5'
Cesspool New Existing 74 „S'
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: /9d',
LOCkT_I_ __ AP: 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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RECEIVED BY: / i _ „„!j,1
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