HomeMy WebLinkAboutWalgo OFFICE OF THE TOWN CLERKF� 4
Town of Southold ���
per. �� •. y
Judith T. Terry, Town Clerk � _ N J'
Town Hall, 53095 Main" Road1 W,3
P. O. Box 1179 C .n F' '.�
Southold, New York 11971
Telephone 2j
(516) 765-1801
- TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 423 Residential x
Fee $ 10.00 Non-Residential •
Septic Cesspool X
NAME OF OWNER: Albert Walgo
OWNER MAILING ADDRESS: Box 193
Mattituck, New York 11952
OWNER PROPERTY ADDRESS: 10895 Sound Avenue
Mattituck, New York
OWNER TELEPHONE NUMBER: 516-298-4418
TAX MAP NO. : Section 141 Block 3 Lot 1
CROSS STREET: Factory Avenue
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: August 14, 1981
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Southold- Town Clerk
DATE: September 16, 1987
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TOWN SEAL)
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OFFICE OF THE TOWN CLERK c.0FIV( .
Town of Southold �� CQG Application No.
Judith T. Terry, Town Clerk u ., 4.
Town Hall, 53095 Main Road =4 `} Residential
P. O. Box 1179 .E Non Residential
Southold, New York 11971 O __ ���`
Telephone .(
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for-
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ �( ✓
DATE
OWNER NAME: L6EFT \vat- G-(2
OWNER MAILING ADDRESS: 13 D x ( 'p 3
oRgS - SouND 1 - V6
OWNER PROPERTY ADDRESS: Ill T l U /` , ,4' •Y
OWNER TELEPHONE NUMBER: , — 4 ( ,(Y'
TAX MAP NO. : Section /�/ Block L3 Lot //
CROSS STREET: A _____
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing A
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: 0,a ,, I — I [ s' 1
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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Signature oflApplicant
RECEIVED BY:
acedown Clerk's Office
DATE: SC®'161g87
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Town Clerk Southold
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