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OFFICE OF THE TOWN CLERK
Town of Southold
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road
P. O. Box 1179
Southold, New York 11971
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERAT ION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 10 Residential XXX
Non-Residential
Fee $ _10. 00 -
Septic Cesspool XXX
NAME OF OWNER: Charles E. Webb
OWNER MAILING ADDRESS: 420 Village Lane
Orient . New York 11957
OWNER PROPERTY ADDRESS: same
OWNER TELEPHONE NUMBER: 323-2672
•
TAX MAP NO. : Section 25 Block 1 Lot q
CROSS STREET: Route 25 Main Road
TYPE OF SYSTEM: Septic Tank New • Existing
Cesspool XXX New Existing XXX
Residential XXX Non-Residential
DATE OF PREVIOUS PUMP-OUT: 1/7/85
Ju id th'T. Terr
Southold Town Clerk
DATE: August 15 . 1986
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK ,COF�C,�4�.
Town of Southold �G Application No. /0
Judith T. Terry, Town Clerk y �)
Residential
Town Hall, 53095 Main Road
P. O. Box 1179 cin O c� *qeit
�i Non-Residential
"^�� �
Southold, New York 11971
Telephone :-461.51—* •
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ 1 LP Btu
DATE
•
1 / / 1
OWNER NAME: (7f 4,-,,1z5 7„/ 9r d , Ve—bi viie
OWNER MAILING ADDRESS: v 411 � L4 y�. &
074 e-71 4-, `7) `�'
OWNER PROPERTY ADDRESS: a (J," LLQ �® e
Q-,-/e wl< 7,11 i01,5• 7
r
OWNER TELEPHONE NUMBER: ,3)3 -
TAX MAP NO. : Section aC -� Block . Lot J' /
CROSS STREET: Ottfe— �� /14 A141 p&Ci
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: VV/R..3-
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.)
e7240/L3 /114/1/—
Signature of Applicant
RECEIVED BY: r;Atlir j /A:
To, n erk's Of`ice
DATE: 0221/
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