HomeMy WebLinkAboutVictoria (2) OFFICE OF THE TOWN CLERK icefg
Town of Southold .%"
Judith T. Terry, Town Clerk #;
Town Hall, 53095 Main Road
P. O. Box 117914r3,_ _, �:
Southold, New York 11971 �0�- •'
Telephone - U.1 �'
- (516), 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 261 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: John and Lucy Victoria
' OWNER MAILING ADDRESS: 1300 Fourth Street-
New Suffolk, New York 11956
OWNER PROPERTY ADDRESS: 1300 Fourth Street
New Suffolk, New York
OWNER TELEPHONE NUMBER: 516-734-6674
TAX MAP NO. : Section 117 Block 7 Lot 6
CROSS STREET: Orchard Street
TYPE OF SYSTEM: Septic Tank X New Existing X
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: December 5, 1986
Judith T. Ter
Southold Town Clerk
DATE: April 7, 1987
(TOWN SEAL)
V..
OFFICE OF THE TOWN CLERK •S\WFO(,r�'=
Town of Southold O�� "CQG Application No. o? /
Judith T. Terry, Town Clerk • .�.r4-4 ,k
Town Hall, 53095 Main Road o , " s
.G ) Residential
P. O. Box 1179 cr3 :" i ;' Non-Residential
Southold, New York 11971 ® ' ` �•`
Telephone
(516) 765-1801 1 � .
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE 3 ' 1 a-3- )
OWNER NAME: )7,;(2„7-?,p)4 Job,'"` )4 JVf
OWNER MAILING ADDRESS: /WO fry
OWNER PROPERTY ADDRESS: ,g /v)
OWNER TELEPHONE NUMBER: 73 3 4"
TAX MAP NO. : Section /I/7 Block 7 Lot
CROSS STREET: (j Jul) j, ,
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: 3-1.17,ec� �ff
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.)
12 -7
Signa re of`"Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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