HomeMy WebLinkAboutTyler OFFICE OF THE TOWN CLERKc0FO
Town of Southold .45T07,
Judith T. Terry, Town Clerk •
Town Hall, 53095 Main Road c
P. 0. Box 1179 cry ;p..,,„ kfifyv
Southold, New York 11971 � gl► o�'••
Telephone ®1 •
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 395 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool X
NAME OF OWNER: Henry Tyler
OWNER MAILING ADDRESS: P.O. Brix 686
Mattituck, New York 11952
OWNER PROPERTY ADDRESS: 230 Bayer Road
Mattituck, New York
OWNER TELEPHONE NUMBER: 516-298-8503
TAX MAP NO. : Section 139 Block 3 Lot 23
CROSS STREET: Grand Avenue
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: 6/4/87
Ju:i h err
Southold Town Clerk
DATE: August 11 , 1987
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK of�FFD
Town of Southold %c31_
c3 reG'., Application No. 6-
Judith T. Terry, Town Clerk x
t• ff:A 7 Residential
Town Hall, 53095 Main Road �,
P. O. Box 1179 �' `• G ' �:' Non-Residential
Southold, New York 11971 O .' '"
Telephone 5 ?i ��
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ 361' `;".5-76"---
DATE
S76DATE g/9',R7
OWNER NAME: Ale n/R °
OWNER MAILING ADDRESS: '--PCD Rm /n• 6
l� f+TF;y0c,j< , /V./. j
OWNER PROPERTY ADDRESS: 430 F [1I eJ i oFjCJ'
;' O /Jc / / q�
OWNER TELEPHONE NUMBER: 97- VS0'3
TAX MAP NO. : Section /,� ° Block 3 Lot 3
CROSS STREET: •, /A fD A V •
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: 6/4L/,g7
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.)
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Signatu'e of 10':plicant
RECEIVED BY:
Town Clerk's Office
DATE:
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