HomeMy WebLinkAboutWilliams (2) 41.
OFFICE OF THE TOWN CLERK • .c.OFOC�'�o
Town of Southold ® + kr
Judith T. Terry, Town Clerk #r ` r eif
Town Hall, 53095 Main Road 1M
P. O. Box 1179 Ln oink i,' • ��
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Southold, New York 11971 OE •
Telephone Oda
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 365 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool x
NAME OF OWNER: Mrs. Hadley B. Williams
OWNER MAILING ADDRESS: 2555 Youngs Avenue. Apt. 15- E
Southold, New York 11971
OWNER PROPERTY ADDRESS: 10725 New Suffolk Avenue
Cutchoque, New York 11935
OWNER TELEPHONE NUMBER: 516-765-5288
TAX- MAP NO. : Section 116 Block i 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: 1978 or 1979?
Judith T. Terry
Southold Town Clerk
DATE: July 29, 1987
(TOWN SEAL) - -
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OFFICE OF THE TOWN CLERK 9S\FFD(r '=
Town of Southold % CQG Application No.-3_
Judith T. Terry, Town Clerk
�‘l Residential
Town Hall, 53095 Main Road c
P. O. Box 1179 cr' 041., •;',:; ' z Non-Residential
Southold, New York 11971 ‘,:`>" tzi . - .$
Telephone ( 0 0
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ l ('„ DO
DATE 7/13/97
OWNER NAME: 12,$, 4
hLE l Li-i44 "
OWNER MAILING ADDRESS: �J�� 6U4/6--s ., APT- if—E.
OWNER PROPERTY ADDRESS: /07o1S- kattf g\O-Ff!04-A Atle:.
CUT f-f-o G--() ) MT 1 /31 3.r."
OWNER TELEPHONE NUMBER:670 `76 �-.S 2gg`
TAX MAP NO. : Section ( f 6 Block 1 Lot
CROSS STREET: AlEW letFr-6Lg Avg.) ou -F-G((v G=u'�'
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential V--- Non-Residential
7 �
DATE OF PREVIOUS PUMP-OUT: 2 ? 7g ' n
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.)
I
—_Leez;61:11.4
itija,
Signa re of Applicant/_
i41./14P 1-7 € GUlLi BIAS
RECEIVED BY: ?a / /.1 _Lae",
T. n &erk's Office
DATE: `7/Q."/7
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