HomeMy WebLinkAboutWalters OFFICE OF THE TOWN CLERK ����(,
Town of Southold " dG
Judith T. Terry, Town Clerk
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Town Hall, 53095 Main Road k "M
P. O. Box 1179 cn k4 "of!
Southold, New York 11971 \ `' '
Telephone ®1 y
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation. Permit No. 527 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool x
NAME OF OWNER: John E. Walters
OWNER MAILING ADDRESS: 385 Cottage Place
Southold, New YOrk 11971
OWNER PROPERTY ADDRESS: 385 Cottage Place
Southold, New York 11971
OWNER TELEPHONE NUMBER: 516-765-5379
TAX MAP NO. : Section 62 Block 3 Lot 17
CROSS STREET: Korn Road
TYPE OF' SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: 1986 _ •
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Judith T. rry
Southold Town Clerk
DATE: December 10, 1987
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK c \fFO( r '=
Town of Southold ��0 F x CQ�' Application No. S027
Judith T. Terry, Town Clerk "A'S
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Town Hall, 53095 Main Road : ' s' %�- :' 7 Residential
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P. -O. Box 1179 �a i u' ' Non-Residential
Southold, New York 11971 � •
Telephone
: 1 •
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ 1.b
DATE I Z 'J 0 .17
OWNER NAME: d\-) ‘\( �� L )ZS
OWNER MAILING ADDRESS: (3 & ( ‘2ts
s; kV 4, N. : 1
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: �l , G S c _2 ?
TAX MAP NO. : Section Block Lot /
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing .\
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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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re '.f Aplic nt
RECEIVED BY: �
t< c v o n1 erk's Offi e
DATE: DEC 1 O 1 i
Town Clerk SouthOI
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