HomeMy WebLinkAboutBuckley (3) OFFICE OF THE TOWN CLERK $ FO�C��
Town of Southold QOSVF
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road
P. 0. Box 1179
Southold, New York 11971
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Telephone — j
(516) 765-1801 `
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 110 Residential X
Non-Residential
Fee $ 10.00
Septic x Cesspool X
NAME OF OWNER: Katherine Buckley
OWNER MAILING ADDRESS: P.O. Box 68, 440 Rogers Road
Sbuthold, New York 11971
OWNER PROPERTY ADDRESS: 440 Rogers Road
Southold, New York
OWNER TELEPHONE NUMBER: 516-765-2538
TAX MAP NO. : Section 66 Block 2 Lot 14
CROSS STREET: Hippodrome Drive
TYPE OF SYSTEM: Septic Tank X New Existing x
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: September 'D 986
Judith T. Terry
Southold Town Clerk
DATE: October 24, 1986
(TOWN SEAL)
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OFFICE-OF THE TOWN CLERK .0 �'=
Town of Southold � C0 Application No.//6
Judith T. Terry, Town Clerk
.� Residential
Town Hall, 53095 Main Road 8 It; ;,
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P. O. Box 1179 � ���, ,�� Non-Residential
Southold, New York 11971 O*4./.414'
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Telephone _ .(
(516) 765-1801
TOWN OF SOUTHOLD
REEVED
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OCT 22'- 1986
Town Clerk Southold APPLICATION
for - -
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. //u
Fee
$ /•686.
DATE / 0//7/5t
OWNER NAME: 4744444:40
ROA _ 4er—
OWNER MAILING ADDRESS: 4140 - • RIC.,
Set - ty
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: '74 5°.. 62515,
TAX MAP NO. : Section CP Block 62i Lot /4/
CROSS STREET:
TYPE OF SYSTEM: Septic Tank ,' New Existing toowx'-
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: g(o
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.)
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Signature of Applicant
RECEIVED BY: 4dc
Town erk's ffice
DATE: / //r6E6
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