HomeMy WebLinkAboutWilliams (4) OFFICE OF THE TOWN CLERK • •c,OFUU(4,�i
Town of Southold
Judith T. Terry, Town Clerk �� ; ` • '}
Town Hall, 53095 Main Road 8 4
P. 0. Box 1179 �
Southold, New York 11971 •�
Telephone i
(516) 765-1801 -
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 611 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool x
•
NAME OF OWNER: Joseph H. Williams and wife
OWNER MAILING ADDRESS: P.O. Box 1263
Southold, New York 11971
OWNER PROPERTY ADDRESS: 2060 Reydon Drive
Southold, New York
OWNER TELEPHONE NUMBER: 516-765-3740
TAX MAP NO. : Section 80 Block 3 Lot 10
CROSS STREET: West Shore Dirve
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: None
• Judith T. Te
Southold Town Clerk
DATE: February 16, "1988
(TOWN -SEAL)
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JESJoseph H. Williams
114 2060 Reydon Drive •
P. 0. Box 1263
Southold, New York 11971
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OFFICE OF THE TOWN CLERK CO Foci(
Town of-Southold �QG'� Application No.
Judith T. Terry, Town Clerk iv Ka ��') Residential
Town Hall, 53095 Main Road o �, -
P. O. Box 1179 y' WW, � i � Non-Residential
Southold, New York 11971 0 0�/
Telephone 1
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. ll
Fee $ •
DATE . /c/,�'53
OWNER NAME: IV/LL /AM-
OWNER MAILING ADDRESS: R 0.6o/ /263
OWNER PROPERTY ADDRESS: d /F,5 YPOIC/ D/r
OWNER TELEPHONE NUMBER: 5/6 - 765 - 74c)
TAX MAP NO. : Section Q, Block Lot /8
CROSS STREET: DW/L-S7` .5//0/z /a -PR / VE
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
- DATE OF PREVIOUS PUMP-OUT: JVOJ' E
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.)
OF
Signature of Applicant
RECEIVED BY: a,�
Town�Cperk's ffice
DATE: 4/(014/