HomeMy WebLinkAboutWilson (2) OFFICE OF THE TOWN CLERK
Town of Southold ���� �CO
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road
P. O. Box 1179 u-311, :
Southold, New York 11971 ,�Q �o�1;-
Telephone ,( Pr
(516) 765-1801
TOWN OF SOUTHOLD -
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 356 Residential X
Fee $ 10.00 - Non-Residential
Septic Cesspool X
NAME OF OWNER: Eleanor Wilson
OWNER MAILING ADDRESS: 34 Woodoak Drive
Westbury, New York 11590 •
OWNER PROPERTY ADDRESS: 345 Clark Road
Southold, New YOrk 11971
OWNER TELEPHONE NUMBER: 516-334-2160
TAX MAP NO. : Section 51 Block 3 Lot 22
CROSS STREET: County Road 48
TYPE OF SYSTEM: Septic Tank New Existing -
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIO_US PUMP-OUT: January 3, 1986; June 13, 1986
Judith T. Terry
' Southold Town Clerk . ,
DATE: July 15, 1987
• (TOWN SEAL) ,
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OFFICE OF THE TOWN CLERK FO
Town of Southold %...--V,." CQG'_ Application No.36
Judith T. Terry, Town Clerk %%� 4 . : �
Town Hall, 53095 Main Road ' `° 14
:G 7 Residential
P. O. Box 1179 cn r" i : Non-Residential
Southold, New York 11971 O Sa {kms ' 'S
Telephone %"(4%----0 '
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
-_. _ _ -- for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ JO •
DATE JU L Y (4 1 ( ?l8
OWNER NAME: E LE A10o2_ (,()I LSOIJ
OWNER MAILING ADDRESS: 3 4 tiloolD0Ak `DSI06
WESTL3v RY I`J_`i . ) 1590
OWNER PROPERTY ADDRESS: 345 CL A ki< (zoA D
So DTI-401-D) UV. ( /71/
OWNER TELEPHONE NUMBER: 51C- 334- 2.I too
TAX MAP NO. : Section 5( Block " 3 Lot 2- 2--
CROSS STREET: CoL to-ry ILOAD 48
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ✓ New Existing
Residential V Non-Residential
- DATE OF PREVIOUS PUMP-OUT: JA 0- 3- 8G — 6,- .13- gC
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.)
7& ?-1
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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