HomeMy WebLinkAboutConroy OFFICE OF THE TOWN CLERK FQUxe
Town of Southold
Judith T. Terry, Town Clerk � 4•44, s *
Town Hall, 53095 Main• Road
P. 0. Box 1179 F cn `w
`
Southold, New York 17 971 '‘'`.0 7®A'`'4'7". �.
Telephone _ o(
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 162 Residential x
Fee $ 10.00 Non-Residential
Septic x Cesspool x
NAME OF OWNER: William Conroy
OWNER MAILING ADDRESS: P.O. Box 1461
Southold, New York 11971
OWNER PROPERTY ADDRESS: Tuthill Road
Southold, New York
OWNER TELEPHONE NUMBER: 516-765-5677
TAX MAP NO. : Section 55 Block 4 Lot 1 .2
CROSS STREET: Yennecott Drive
TYPE OF SYSTEM: Septic Tank X New Existing x
Cesspool X New - ;Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: July 1 , 1986
Judith T. Terry
Southold Town Clerk
DATE: December 1 , 1986
(TOWN SEAL)
•1
" "'-
OFFICE OF THE TOWN CLERK " , c�VFFDC,,
Town of Southold �� CQ ' Application No./
Judith T. Terry, Town Clerk �` �; �
7
,, aC Residential
Town Hall, 53095 Main Road 8 .�..�
P. O. Box 1179 cn -- A'.;h Non-Residential
Southold, New -York 11971 0< 0�'�`
Telephone j '°
(516) 765-1801
TOWN OF SOUTHOLD _
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPT IC•TANK or CESSPOOL
Operation Permit No. /
Fee $ /6
} DATE / j c
OWNER NAME:
pa
OWNER MAILING ADDRESS: / //j! w- / / 'y /[k/
OWNER PROPERTY ADDRESS: 5.41'14
OWNER TELEPHONE NUMBER: 27,37
TAX MAP NO. : Section 33 Block Lot / Q.
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool 4. New Existing
Residential V Non-Residential
DATE OF PREVIOUS PUMP-OUT: 7 47/ /g
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.)
Signature Applicant
RECEIVED BY: ;- cc-o__�
Town Clkrk's Offce
DATE: REM
DEC 01 . ,.,
Tour Clerk So thrid
ity
50 6- /0 ey_td,
1_ fr
/2b
-"At':