HomeMy WebLinkAboutCarr (2) OFFICE'OF 7r HE TOWN CLERK ��f�
Town of Southold �� '' •
Judith T. Terry, Town Clerkpi , { �"
Town Hall, 53095 Main Road cf ,
P. 0. Box 1179 w
Southold, New York 11971 % ®
Telephone _ zit
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation_ Permit No. 570 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: Ruth Carr
OWNER MAILING ADDRESS: 4295 Pequash Avenue
Cutchoque, New York 11935
OWNER PROPERTY ADDRESS: 4295 Pequash Avenue
Cutchoque, New York 11935
OWNER TELEPHONE NUMBER: 516-734-5838 -
TAX MAP NO. : Section 137 Block 2 Lot 16
CROSS STREET: Stillwater Avenue
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing _ x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: 1985
Judith T. T ry
Southold Town Clerk
DATE: January 11 , 1988
•
•
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK •• ea,
Town of Southold �® C'® Application No.
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road o Residential
P. O. Box 1179 cap � � tri ; Non-Residential
Southold, New York 11971 as
Telephone __
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
• OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE 3lel 7
OWNER NAME: fe0 T /4 C R
OWNER MAILING ADDRESS: I 9 ,5'" U
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: 7 3 9 - Sr 3 g)
TAX MAP NO. : Section /3 7 Block Lot / 'b
CROSS STREET: O
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing ti
Residential --)c Non-Residential
DATE OF PREVIOUS PUMP-OUT:
g7 '�
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.)
e.a:* cQeit�
Signature of Applicant
RECEIVED BY: Mt/l-c -'-
' IN-Fdavn CI k's Offce
DATE: JAM 11187
lnwP, Clerk Southold