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HomeMy WebLinkAboutConway OFFICE OF THE TOWN CLERK ,c0FeUri--i Town of Southold Judith T. Terry, Town Clerk Town Hall, 53095 Main Road P. 0. Box 1179 o tte,� 4 Southold, New York 11971 �- �o o Telephone Alt lt (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 287 Residential X Fee $ 10.00 Non-Residential Septic Cesspool X NAME OF OWNER: Lorraine Conway OWNER MAILING ADDRESS: 760 Chestnut Road Southold, New York 11971 - OWNER 1971 -OWNER PROPERTY ADDRESS: 760 Chestnut Road Southold, New York OWNER TELEPHONE NUMBER: 516-765-2021 TAX MAP NO. : Section 59 Block 3 Lot c CROSS STREET: Maple Road TYPE OF SYSTEM: Septic Tank New Existing Cesspool X New Existing Residential X Non-Residential DATE OF PREVIOUS PUMP-OUT: December 15, 1986 Judith T. Terry Southold Town Cler DATE: April 23, 1987 (TOWN ,SEAL) 3 i11 11 I s OFFICE OF THE TOWN CLERK \\FFptA;'- ' �l Town of Southold �Q CQ Appli- cation No. c Judith T. Terry, Town Clerk Town Hall, 53095 Main Road rC Residential P. 0. Box 1179 u' � p � �z Non-Residential Southold, New York 11971 O ® ,--- •` Telephone411Y► (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLI CAT ION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ )b DATE 3/025/J7 OWNER NAME: / f / fftJ .0 CON t4rA"/ OWNER MAILING ADDRESS: 16Co &E' .IV44 Rd a( oD"f , ,,cc/ ,/ 97/ OWNER PROPERTY ADDRESS: SoL‘cy\P � c). kP OWNER TELEPHONE NUMBER: 1/4 -11(4)-- 1 (S - 00- TAX MAP NO. : Section Block C3 Lot CROSS STREET: 014 p le 14 TYPE OF SYSTEM: Septic Tank New Existing Cesspool New Existing ?� Residential Non-Residential DATE OF PREVIOUS PUMP-OUT: /°0.--5-40 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.) .41 • OPP „ Signature oad.) Signature of Applica RECEIVED BY: Townrk's Oce R E EIV5D DATE: APR 23 6987 Town Clerk Southold ell ---, :40‘s,10 till s 3 U o L z ei . c..) ©c 3