HomeMy WebLinkAboutWood OFFICE OF THE TOWN CLERK ' '
Town of Southold 5��F� COG
Judith T. Terry, Town Clerk
Town Hall, - 53095 Main Road l x .
P. O. Box 1179 n 0
Southold, New York 11971 •
Telephone *'?1 , •
(516) 765-1801• ' -
• " TOWN OF SOUTHOLD
•
• SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 436 "Residential X
Fee $ 10.00
Non-Residential
• Septic x Cesspool
NAME OF OWNER: John E. and' Amelia Wood
OWNER MAILING ADDRESS: 3150 -Ole Jule Lane •
•
Mattituck, New York 11952
• OWNER PROPERTY ADDRESS: 3150 Ole Jule Lane
-
_ Mattituck, New York
OWNER TELEPHONE NUMBER: 516-298-8509
TAX MAP NO. : Section 122 Block 4 s Lot 19
CROSS STREET: Krauss Road
TYPE OF SYSTEM: Septic Tank X New Existing X
Cesspool New Existing
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: May 1983
•
T rry
Southold Town Clerk
DATE: September 28, 1987
•
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(TOWN•; SEAL)
- • - 1,
OFFICE OF THE TOWN CLERK
Town of Southold Application No. G
Judith T. Terry, Town ClerkF �`,
Town Hall, 53095 Main Road ~ �` '�' '4 ! Residential
P. 0. Box 1179 � Non-Residential
Southold, New York 11971 "14.4; ��'
Telephone : ./ �
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 14.3
•
Fee $ /Q Po
DATE S '/. y/i /�g7
OWNER NAME: v61I(.) )L /LIE-Cl/9 tO6c11
OWNER MAILING ADDRESS: 3/.50 OLE' (.77(-4— / 6-'
//4*1-; pecc k
OWNER PROPERTY ADDRESS: .5/9•Me"
OWNER TELEPHONE NUMBER: A - 8 S'Oe
TAX MAP NO. : Section 0 Z'L ' Block Lot 1
CROSS STREET: / -'ac5 ' + \D&4
TYPE OF SYSTEM:• Septic Tank New Existing _ ✓
Cesspool • -New Existing
Residential Non-Residential
Q
------ DATE OF PREVIOUS PUMP-OUT: filo p3
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.)
4f4t1/1000/
Signature .f Applican
RECEIVED BY: 414,
To ,n CI'rk's ffice
DATE: TA2VS7
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