HomeMy WebLinkAboutChamberlain OFFICE OF THE TOWN CLERK • °CZFD
Town of Southold clj
Judith T. Terry, Town Clerk �� {�' y
Town Hall, - 53095 Main Road 1 �
P. O. Box 1179 C\ n r r r.
Southold, New York 11971 Q ,»'
Telephone -:.4110/ iti-P
(516) 765-1801
- TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
•
Operation Permit No. 406 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool X
NAME OF OWNER: Kathleen Chamberlain
OWNER MAILING ADDRESS: P.O. Box 406
Peconic, New York 11958
OWNER PROPERTY ADDRESS: Huntington Blvd.
Peconic, New York 11958
OWNER TELEPHONE NUMBER: 516-765-1604
TAX MAP NO. : Section 67 Block 3 Lot 7
CROSS STREET: Lake View Avenue
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New ExistingX
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: March 23, 1987
Judith T. Terry
Southold Town Clerk
DATE: August 19, 1987
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK C��FO��Q=
Town of Southold �� ,� • .. G Application No. 9D‘'
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road ' : Residential
P. O. Box 1179 to x n � Non-Residential
Southold, New York 11971 ����''
Telephone .i
(516) 765-1801
TOWN OF SOUTHOLD
RECEIVED SOUTHOLD WASTEWATER DISPOSAL DISTRICT
AUG 13 1987
APPLICAT ION
Town Clerk Southold
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.'/O6
Fee $ j®�
DATE g/ii/g7
OWNER NAME: ake/vY1%a-bwi i >
OWNER MAILING ADDRESS: A® &)X /O '
ig,e/Ae2oie /1, 1
OWNER PROPERTY ADDRESS: ge 17`y 10/7 & 'd
P
OWNER TELEPHONE NUMBER: /6 7S' i6t/
TAX MAP NO. : Section 6� 7 Block 3 Lot 7
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential I Non-Residential
DATE OF PREVIOUS PUMP-OUT: fl'J6✓1GV1 3 d 1 V 7
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.)
//(4,,,Leze. 4 gAco d.0ewvt_d
Signature of Applicant
RECEIVED A,:._:t_ I, ' �..7 •
* Town i lerk's ((ffice
DATE: AUG 191981
Southold town Clerk
Lot - Is house and cesspool system located on all three lots? Please advise.
Location map was not included.
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