HomeMy WebLinkAboutTuthill (7) - J
OFFICE OF THE TOWN CLERK �� o(K`,'
Town of Southold �. 44
Judith T. Terry, Town Clerk ; ,P4 J'
Town Hall, 53095 Main Road ti
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P. O. Box 1179 cn
Southold, New York 11971 �0' •
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Telephone 0./ Aid � '
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION- PERMIT
• SEPTIC TANK or CESSPOOL
Operation Permit No. 284 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool x
NAME OF OWNER: Frances A. Tuthill
OWNER MAILING ADDRESS: 700 Summer Lane
Southold, New YOrk 11971
OWNER PROPERTY ADDRESS: 700 Summer Lane
Southold, New York
OWNER TELEPHONE NUMBER: 516-765-1183
TAX MAP NO. : Section 78 Block 9 Lot 19
CROSS STREET: N. Bayview Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: December 5, 1986
Judith T. Term'""""'
Southold Town C erk
DATE: April 22, 1987
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK c��l"FO(,r
Town of Southold �� C'Q z. Application No. 7
Judith T. Terry, Town Clerk ` k z .}
Town Hall, 53095 Main Road 4444 -� Residential t/
P. O. Box 1179 a _ i ; Non-Residential
Southold, New York 11971 O ®
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Telephone
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ .0. °,°
DATE
OWNER NAME: FA-04. (,aa., (id
OWNER MAILING ADDRESS: 700
it
OWNER PROPERTY ADDRESS: S' .
OWNER TELEPHONE NUMBER: (5 70 7e9--1(83
TAX MAP NO. : Section '7? Block 9 Lot /7
CROSS STREET: `1. E',
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing ✓ '
Residential ✓ Non-Residential
DATE OF PREVIOUS PUMP-OUT: • 0- /f er6
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.)
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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I•UTtiORIZ ALTERATION OR ADDITION• J(c �So/7 Le CRL fLL. • 301 I $1
+ HIS SUR EY IS A VIOLATION OF > to11
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