HomeMy WebLinkAboutBertram OFFICE OF THE TOWN CLERK c# ' L(r''
Town of Southold 4 ,16_
Judith T. Terry, Town Clerk 1 r110
Town Hall, 53095 Main Road i 3 ;
P. O. Box 1179 v' `r-4 .,s �
Southold, New York 11971 ��-
Telephone _201
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation- Permit No. 545 Residential X
Non-Residential
Fee $ 10.00 Septic Cesspool X
NAME OF OWNER: Bertram W. and Margery M. Walker
OWNER MAILING ADDRESS: P.O. Box 1169
Mattituck, New York 11952
OWNER PROPERTY ADDRESS: Peconic Bay Blvd. (Edqemere Park)
Laurel, New York
OWNER TELEPHONE NUMBER: 516-298-8123
TAX MAP NO. : Section 145 Block 4 Lot 14
CROSS STREET: McDonald's Path
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: March 1986 -
dratiaitoroo,
Judith
Southold Town Clerk
DATE: December 21, 1q87
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(TOWN ,SEAL)
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'OFFICE OF THE TOWN CLERK cOF �'=
Town of Southold �� . - �G Application No. &"1-45J
Judith T. Terry, Town Clerk --
Town Hall, 53095 Main Road Residential
P. O. Box 1179 u-3 z Non-Residential
Southold, New York 11971 '�_ ti•. •`
Telephone •
�� •
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 6"-e-{5---
Fee
13Fee $ •
DATE /O) / %•
��
OWNER NAME: e� 'cri,'1 LC/ c,� �� y 7{1, 2� � 9-
OWNER MAILING ADDRESS: O- `t7z 7/6
�ci��c, N
OWNER PROPERTY ADDRESS: 7(-2)c0,-tic --aa.. "
/.�c �4c/ <�c/lC/�c'rc-?ce ��
OWNER TELEPHONE NUMBER: 6:72--9 - 7/„)-$
TAX MAP NO. : Section /43-- Block Lot /..
CROSS STREET: c.0j.-)e/c/
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: 2/ef6'
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.)
2/4 rf
Signature of Applicant
RECEIVED BY: do,a64)
Townerk's Office
RECEIVED
DATE: DEC 21 1387
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