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OFFJC-E° OF THE TOWN CLERK • �4fjr�[/� - -
Town of Southold , OQ� y ,
Judith T. Terry, Town Clerk I ?�; t, - - -
Town Hall, _ 53095 Main Road t
P. O. Box 1179
Southold, New York 11971 Q ® �- � -
Telephone VO-(
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation-Permit No. 400 Residential X
Non-Residential
- - Fee $ - 10.00
Septic Cesspool X
NAME OF OWNER: Leonard Vail
OWNER MAILING ADDRESS: 150 Vincent Street
Orient, New York 11957
OWNER PROPERTY ADDRESS: 150 Vincent Street
Orient, New York
- OWNER TELEPHONE NUMBER: 516-323-2588
TAX MAP NO. : Section 25 Block 3 Lot 13
CROSS STREET: Willow Street and Fletcher Street
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: August 14, 1984 •
T Torrw
Southold Town Clerk
DATE: August 14, 1987 -
(TOWN SEAL)
OFFICE OF THE TOWN CLERK cvFFOLr��=
Town of Southold �% Application No.'i
Judith T. Terry, Town Clerk
i
Town Hall, 53095 Main Road r ;G l Residential
ow
P. O. Box 1179 r Non-Residential
Southold, New York 11971 O ® if 7—
Y
Telephone %1.( y ¢ I
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
$ /D
Fee
DATE ' 174 -- i7
OWNER NAME: cz 7a_e_j(
OWNER MAILING ADDRESS: `9D 241
:rhv 2 2"S-7
OWNER PROPERTY -ADDRESS:
OWNER TELEPHONE NUMBER: Ycl3— 6-e8
TAX MAP NO. : Section - Block Lot /3
CROSS STREET:. e",„0 �tr�u��
TYPE OF SYSTEM: Septic Tank New Existing ✓
Cesspool 1/ , New Existing
Residential // Non-Residential
DATE OF PREVIOUS PUMP-OUT: l �
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.)
AddiP
ignature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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