HomeMy WebLinkAboutBurns OFFICE OF THE TOWN CLERK IFU
Town of Southold ���� 0
Judith T. Terry, Town Clerk 'k" ', �
Town Hall, 53095 Main Road Y4.-.1. 'y'r 'mac
P. 0. Box 1179
Southold, New York 11971 O,y, µ•_ms' " �0���1,
Telephone _Ojt V
(516) 765-1801 ' _ I--
TOWN
"TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 303 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool X
NAME OF OWNER: John J. and E. Margaret Burns
OWNER MAILING ADDRESS: P.O. Box 344
Laurel, New York 11948
OWNER PROPERTY ADDRESS: Peconic Bay Blvd.
Laurel, New York
OWNER TELEPHONE NUMBER: 516-298-8073
TAX MAP NO. : Section 145 Block 2 Lot 14
CROSS STREET: Opposite Street - Laurelwood Drive
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Ocotber 1986
Judith T. Ter
Southold Town Clerk
DATE: May 12, 1987
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK c�VfFilL
Town of Southold �% �Q ' , Application N 0
Judith T. Terry, Town Clerk �` a` I.:. %,%)
: .: — Residential
Town Hall, 53095 Main Road a r� ,..:;}
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P. O. Box 1179 � k *.. ,:-, ��`' Non-Residential
Southold, New York 11971 ® O 1, ,i. ���`
Telephone _ • ''
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
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OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ ID, of
. DATE S Ic2 'g7
OWNER NAME: ,JCJN/af M it- / RCiiIR E i & a, is
OWNER MAILING ADDRESS: R&&X' 3/41/- %i=CcaiJa� /347- & tt)
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OWNER PROPERTY ADDRESS: /' e&'/../a G /34y' /&eve. , Z. ,eE Afli/999;
OWNER TELEPHONE NUMBER: (57 - 2 9 k- {So 7-?
TAX MAP NO. : Section /#.6.-, -2- /'/Block 2 Lot 16
CROSS STREET: /0p�/ 7-r 57-- 12i i — 2/k(Aei4. WOOD J)fiit/t:
TYPE OF 'SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: 67-0/3 r ? /y 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.)
./ a 144/744>
Signatur of Applicant
RECEIVED BY: t101°'-
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Town Clr�.s 0 fice
DATE: -__ ! .- 7
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