HomeMy WebLinkAboutCarlin 1- rrt
OFFICE OF THE TOWN CLERK (}
Town of Southold .1r. ' lilj
Judith T. Terry, Town Clerk � , ` . rt ;,
Town Hall, 53095 Main Road
P. 0. Box 1179 to 's ` ",
Southold, New York 11971 p 3,.
Telephone T/
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 369 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool x
NAME OF OWNER: Andrew J. and' Hazel F. Carlin
OWNER MAILING ADDRESS: 220 Broadwaters Road
Cutchogue, New York 11935
OWNER PROPERTY ADDRESS: 220 Braodwaters Road
Cutchogue, New YOrk
OWNER TELEPHONE NUMBER: 516-734-6123
TAX- MAP NO. : Section 104 Block 10 Lot 7
CROSS STREET: Vanston Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
Judith T. Terry
Southold Town Clerk
DATE: July 29. 1987
(TOWN SEAL)
?tr..; I' ••• a,
OFFICE OF THE TOWN CLERK ciWFOC,r
Town of Southold Oho - �,. CQ '� Application No. 6?
Judith T. Terry, Town Clerk r ,•4,
�,-,r _ 3 '. Residential
Town Hall, 53095 Main Road �
P. O. Box 1179 cs3 . , 4 ',� ° tri�; Non-Residential
Southold, New York 11971 O � �.F�O�'��`
Telephone .( ►
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE SO L gl 1 IS- I
OWNER NAME: AN D 2 w . 6-Lived 14CA,2,e,I f . Co-P-1-1 N
OWNER MAILING ADDRESS: AAO OFtock.�ta.)c. -e - Roc
Cu +a..aJu 11 .Y. 1 t ' 13-
OWNER PROPERTY ADDRESS: .n. cs s. A.e,c ;,�e-b,A-..e i-S 4:2or.-cd
et) -4=--, ,,,,,.,..:e li .y. 1 t 7 �.�
OWNER TELEPHONE NUMBER: 134 - 491 23
1SC - 4 /e) 9 L0 -7
TAX MAP NO. :# Section - Aro , S- Block Lot I S A)
CROSS STREET: (11ev_;, -r c,c.=SS S -. .1 S Viz.rtS`-6-o I-G`)
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool V/ New Existing V.
Residential /✓ Non-Residential
DATE OF PREVIOUS PUMP-OUT: ? ?
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.)
c------
Signa& re of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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