HomeMy WebLinkAboutWelles OFFICE OF THE TOWN CLERK .x" ���Fair'
Town of Southold
Judith T. Terry, Town Clerk :r
Town Hall, 53095 Main Road c4:1';;;,
P. 0. Box 1179 cn ` `x,
Southold, New York 11971 \ O '`® `t- 7
Telephone _4/I
(516) 765-1801 `
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 523 Residential x
Non-Residential
Fee $ 10.00
Septic Cesspool x
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NAME OF OWNER: Christopher, Prentice and James Welles
c/o Grace B. Welles
OWNER MAILING ADDRESS: P.O. Box 821
Orient, New York 11957
OWNER PROPERTY ADDRESS: 275 Munn Lane '
Orient. New York .
OWNER TELEPHONE NUMBER: 516-323-3594
TAX MAP NO. : Section 17 Block 3 Lot. 8
CROSS STREET: Main Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X,
Residential X Non-Residential
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DATE OF PREVIOUS PUMP-OUT: 1986
` �•r
Judith T. Ter'y
Southold Town Clerk
DATE: December 7. 1987
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(TOWN SEAL)
5020 .
OFFICE OF THE TOWN CLERK
is�� FRO( -
Town of Southold ��� .y - (Q ..' Application No.
Judith T. Terry, Town Clerk . --
Town Hall, 53095 Main Road ~ ' =,....1,„ --! .,- ='- Residential
P. O. Box 1179 crs ,,, y : i %' Non-Residential
® '
Southold, New York 11971 O '-` s . z.$
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Telephone %';')\''
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ 10' ,6-5"----°
DATE tZ — 3 — �%
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OWNER NAME: VV e (,,,, , Gt—'�-�� 73rre -
JC-L(Vl_L S
OWNER MAILING ADDRESS: Pa S2-3• C'9 tea t--- N) y
tL 7
OWNER PROPERTY ADDRESS: ,2- '7 e'- ick cvNJ L_c� 0... ---
OWNER TELEPHONE NUMBER: N5-1 • '3 -- S VY
TAX MAP NO. : Section j7 Block \;y 3 Lot k
i
CROSS STREET/YOIV
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool /7"----- New Existing
Residential v Non-Residential
DATE OF PREVIOUS PUMP-OUT: / 9,Cr1,
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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JQ.-C-a-ft(Y
Signature of Applicant
RECEIVED BY: ear
Town CI rk's O fice
DATE:
DEC ®7 IN
Tnwn Clerk Southold
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