HomeMy WebLinkAboutWells (2) OFFICE OF THE TOWN CLERK 0(K
Town of Southold
Judith T. Terry, Town Clerk � = ,e` -
Town Hall, 53095 Main Road a •r
P. O. Box 1179 s. •
Southold, New York 11971
Telephone
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(516) 765-1801 ,
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 297 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: Theodore R. Wells and wife
OWNER MAILING ADDRESS: 1575 Cox Neck Road
Mattituck, New York 11952 '
OWNER PROPERTY ADDRESS: 1575 Cox Neck Road
Mattituck, New York 11952
OWNER TELEPHONE NUMBER: 516-298-4666
TAX MAP NO. : Section 113 Block 7 Lot
CROSS STREET: Westphalia Road _
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
Judith T. Terry
Southold Town Clerk
DATE: May 4, 1987
(TOWN SEAL) S
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OFFICE OF THE TOWN CLERK r\ -7-� '=
Town of Southold �� µ. . CQG' Application No. 7.
Judith T. Terry, Town Clerk
p } a ° ,G Al,, Residential
Town Hall, 53095 Main Road ar-P. O. Box 1179 Y.' '1%. � ' i ,�, Non-Residential
Southold, New York 11971 O •®1/4 r kyr/$
Telephone 0 i 09
(516) 765-1801
TOWN OF SOUTHOLD-
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for _ '
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ H.2, °°
DATE (/ ??
OWNER NAME: /,1,D 0 ii,./ p G,i a/s Y- Ph i
OWNER MAILING ADDRESS: / '7 ( ( 6)C Airge_i g)
MA-Ti T 0 C t /may /((%,(---,)--
OWNER PROPERTY ADDRESS: 3 7)- 144
OWNER TELEPHONE NUMBER: d '9 ?'-- ,/t). ,6‘;,
y TAX MAP NO. : Section I 3 Block ) `-f rLot / -
CROSS STREET: WN j /914 (`I /4 RP \
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool /�� New Existing ,�
Residential 1/ 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.)
S--------- - : "://," _
Signature of Applicant
RECEIVED BY: °.:OPAINIIIP ,/ r
mw - s Office
DATE: L,-._.A7)7/C17
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