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Town Hall, 53095 Main Road
® �`� P.O. Box 1179
=y . --.0 Southold, New York 11971
JUDITH T.TERRY - _®1~ �,���� TELEPHONE
TOWN CLERK '�'"'�/��0 (516) 765-1801
REGISTRAR OF VITAL S CATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 818-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner WINTERS, HAROLD D.
Mailing Address 1 WINTERS, MARCELLA F.
Mailing Address 2 505 CUSTER AVENUE
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 505 CUSTER AVENUE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-2946
Tax Map No. section 70.00 block 8 lot 24.000
Cross Street BENNETT' S LANE
Date Of Last Pump Out 0/00/84
Issue Date: 9/08/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
I IIS •
OFFICE OF THE TOWN CLERK �c��FFO(,'�'=
Town of Southold A 4*. COl•• Application No.
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road 7 Residential
O. Box 1179 cry =t ` .w.: z Non-Residential
Southold, New York 11971 Q '�_t }- ��•
Telephone Y►�� '��
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE September 8,1988
OWNER NAME: Harold D Winters & Marcella F Winters
OWNER MAILING ADDRESS: 505 Custer Avenue
Southold,New York 11971
OWNER PROPERTY ADDRESS: Same as above
OWNER TELEPHONE NUMBER: 516-765-2946
TAX MAP NO. : Section "7O Block , Lot a'
CROSS STREET: Bennett's Lane
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool # New Existing #
Residential # Non-Residential
DATE OF PREVIOUS PUMP-OUT: 1984
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.)
•
Signatu e of App?cant
RECEIVED BY:
Town Clerk's Office
DATE:
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