HomeMy WebLinkAboutCornell OFFICE OF THE TOWN CLERK • C�FFIRJI'I,�
Town of Southold
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road a
P. 0. Box 1179 as. s�
Southold, New York 11971 O
Telephone _ (
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 202 Residential x
Non-Residential
Fee $ 10.00 Septic X Cesspool
NAME OF OWNER: Clifford Cornell
OWNER MAILING ADDRESS: 325 Willow Point Road
Southold, New York 11971
OWNER PROPERTY ADDRESS: 325 Willow Point Road
Southold, New York
OWNER TELEPHONE NUMBER: 516-765-2834
TAX MAP NO. : Section 56 Block 5 Lot 26
CROSS STREET: Bay Home Road
TYPE OF SYSTEM: Septic Tank X New Existing x
Cesspool New Existing
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
Ju 'T. erry
Southold Town CI rk
DATE: January 16, 1987
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK c,VFFD(,r�'-
Town of Southold V� xyx '22 Application No.020 ''
Judith T. Terry, Town Clerk �`�,e.4.,t-
'! . 1} Residential `/
Town Hall, 53095 Main Road ,�,..
P. O. Box 1179 �' Pii �; Non-Residential
Southold, New York 11971 O ® ,�_ �O� �`
Telephone _ ,( . Y► '�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 020,1-)
Fee $ /0.C9'
DATE —"/--g---e7
OWNER NAME: 6/,---pan O 1'U5Z1_---'
OWNER MAILING ADDRESS: --2 ",)._<---6<.1// L ,JY '
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So .,t (( O )Ct /JL l (of-71
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OWNER PROPERTY ADDRESS: S4 i f
OWNER TELEPHONE NUMBER: 7bc -' 7"
TAX MAP NO. : Section -6 Block ..5- Lot c�
CROSS STREET: /0) A 1,1 1)►i/l- Kms/\
11,
TYPE OF SYSTEM: Septic Tank New Existing f\—
Cesspool New Existing
Residential �/ Non-Residential
DATE OF PREVIOUS PUMP-OUT: U,I,L ,yl l 60 J vii
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.)
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L' A.,i .Q 't ) 4:Le--it_e
rii / Signature of Applicant
RECEIVED BY: y IV 2
RPCIPA Clerk's ffice
DATE: JAN 1 6 1987
Town Clerk Southold