HomeMy WebLinkAboutTully OFFICE OF THE TOWN CLERK , a S0FULA'C'
Town of Southold - 1 �Q { .,
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road
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P. O. Box 1179 `�
Southold, New York 11971 per;® '`,` •'
Telephone " j44.$
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
- - OPERATION PERMIT
" SEPTIC TANK or CESSPOOL
Operation Permit No. 433 ° ' Residential X -
Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: Carolyn and Francis Tully
OWNER MAILING ADDRESS: 'P.O. Box 49
' EAst Marion, New York 11939
OWNER PROPERTY ADDRESS: Old Orchard Lane
East Marion, New York
OWNER TELEPHONE NUMBER: 516-477-2064
TAX MAP-NO. : Section 37 Block 3 Lot 2
CROSS STREET: South-Dri iie
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing
Residential X Non-Residential
DATE- OF PREVIOUS PUMP-OUT: Unknown
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Judith T. T ry
Southold Town Clerk
DATE: September 17, 1987
(TOWN, 'SEAL)
OFFICE OF THE TOWN CLERK ���FF�(4.�
Town of Southold OHO� �-, CQG' , Application No. 31
Judith T. Terry, Town Clerk G
Town Hall, 53095 Main Road s-, '�-; t.. '4 Residential
P. O. Box 1179 Er3 riti:� 1 �,��` - Non-Residential
Southold, New York 11971 O ®s 0� '
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Telephone _�( Y►�
.'
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ ' /A 0z)
DATE 9- /7- 77
OWNER NAME: Cg7304 d�/ Gt}- l/6>,1YA1 Aldi 4/4
OWNER MAILING ADDR' SS: ,/PO `?. 4/---- ( ,
lam:G4-. ) /0,44199/4/.
3 - >`' .4j A/ 4i ..5/74
OWNER PROPERTY ADDRESS: 7/ Z ( ec,i4 (J t"1 /Alm
OWNER TELEPHONE NUMBER: 76 - ?)-m 6 C
TAX MAP NO. : Section 27 - Block 2 Lot /w,'; 4,
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CROSS STREET: -....co ti�{'4 �t i/e_
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool t—" New tom- Existing
Residential t.-.
DATE OF PREVIOUS PUMP-OUT: r
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.)
, 7(/. ./5_
712/4Oe-4/1
Appli
Signature of nt
RECEIVED BY: `�/_ _ ,, //' ,
.wn J le' 's Office
DATE: // 2'f
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