HomeMy WebLinkAboutWeild OFFICE OF THE TOWN CLERK •• 'cO(��;'
Town of Southold ,
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road
P. 0. Box 1179 113
Southold, New York 11971 O y �� •�
• Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 114 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: Elizabeth M Weild
OWNER MAILING ADDRESS: 484 Siwanoy Place
Pelham Manor,rNew_-York 10803
OWNER PROPERTY ADDRESS: 10450 New Suffolk Avenue
Cutchoque, New York
OWNER TELEPHONE NUMBER: 914-738-2764
TAX MAP NO. : Section 116 Block 6 Lot 5
CROSS STREET: Linden Avenue
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X ' New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: August 5, 1986
Oltri.e44<et.fi %ell/WY'
Southold Town ererk
DATE: October- 30, 1986
(TOWN SEAL) -
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`OFFICE OF THE TOWN CLERK c,VFFO(,r
Town of Southold COG', Application No. f//
,AgJudith T. Terry, Town Clerk i.. '
s Residential C.
Town Hall, 53095 Main Road
P. O. Box 1179 vp
' Non-Residential
�'
Southold, New York 11971 O' i ' >,`
Telephone -_"off ' y►��;;�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
RECEIVED APPLICATION
OCT e 3 1986 - -
vaRlarinufnold OPERATION PERMIT
OCT y 01. ; SEPTIC TANK or CESSPOOL
Ton Cteri, Wald `/
Operation Permit No. //7
Fee $ /06)
DATE . �� ij'�1 ' /9g�
OWNER NAME: AjeZ 7)1 .` �
OWNER MAILING ADDRESS: Ail&32' altd1
..7, , /®c
OWNER -PROPERTY ADDRESS: 1 e}` L 3.6 71.a44. //
OWNER TELEPHONE NUMBER:Ms/1.. '-- yt1 • c
TAX MAP NO. : Section /,/lo Block 6 Lot <5.--
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool . New Existing ,-
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: .:I `-/ 9,4) ,7Zert-u.4..)
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.)
gnature of Applicant
RECEIVED BY: £ __ . (�
Town Crk's Orfice
DATE: ae„&(_5,-6._6„ cG, `Sg-
`r L .
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