HomeMy WebLinkAboutCorwin OFFICE OF THE TOWN CLERK
Town of Southold
,6 '�, t
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road
P. O. Box 1179 . ��'
- Southold, New York 11971 �i1 , . �►����'t,
Telephone �/ * '
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 28 Residential XX
Non-Residential
Fee $ 10.00
Septic Cesspool xx
NAME OF OWNER: William H. Corwin
OWNER MAILING ADDRESS: 8 Randolph Avenue
Mine HIll, Dover, New Jersey 07801
OWNER PROPERTY ADDRESS: New Suffolk Avenue
New Suffolk, New York
OWNER TELEPHONE NUMBER: 201-366-6182
TAX MAP NO. : Section 1116 Block 3 Lot 17
CROSS STREET: Jackson Street
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool xx New xx Existing
(Replacement)
Residential XX Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
Judith T. Terry
Southold Town Cle
DATE: August 25 1986
(TOWN SEAL)
OFFICE OF THE TOWN CLERK SW Fair
Town of Southold r 44-1
Town
Application No.
Judith T. Terry, Town Clerk .� _
Town Hall, 53095 Main Road Residential
•
P. O. Box 1179 cn ` i ; Non-Residential
Southold, New York 11971 O
Telephone ®.( 1,s6
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. oW
Fee $ /
DATE 0--(o
OWNER NAME: William H. Corwin
OWNER MAILING ADDRESS: 8 Randolph. Avenue
Mine Hill, Dover, New Jersey 07801
OWNER PROPERTY ADDRESS: _ New Suffolk, Avenue_ - _ ,_
New Suffolk, New York
OWNER TELEPHONE NUMBER: - 6 /A7 C2.'
TAX MAP NO. : Section 10000-16 Block 3 Lot 17
Jackson Street
CROSS STREET: '
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ,/ New 1/ E fisting
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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.)
/7 ;gnature of Applicant
RECEIVED BY: at..,),Lci
Town Clerig Offi e
DATE:
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