HomeMy WebLinkAboutCoutts OFFICE OF THE TOWN CLERK cpi-dC %
Town of Southold t
Judith T. Terry, Town Clerk E 1
Town Hall,
Main Road
P. 0. Box 1179 ' cr� - e4'' Y :
Southold, New York 11971 \ e> �;
44
Telephone ' oma/
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERAT ION PERMIT
SEPTIC TANK or CESSPOOL
Operation" Permit No. 524 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool X'
NAME OF OWNER: Walter Coutts
OWNER MAILING ADDRESS: 1425 Leeward Drive
Southold. New York 11971
OWNER PROPERTY ADDRESS: 1425 Leeward Drive
Southold, New York •
OWNER TELEPHONE NUMBER: 516-765-1042
TAX MAP NO. : Section 79 Block 7 Lot 20
CROSS STREET: Topsail Lane
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: 1986
Southold Town lerk
DATE: December -7, 1987
(TOWN SEAL)
.. „� -
:: FFICE OF THE TOWN CLERK '�
S�FFO(,I '`�
Town of Southold?lle
®�� w CQG� Application No�
Judith T. Terry, Town Clerk , i �� Residential
Town Hall, 53095 Main Road
P. O. Box 1179 u' V 1:4i ;' Non-Residential ,
Southold, New York 11971 ‘..p :(ii `- $
r O\',.
Telephone -gel- �as � .'
(516) . 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
. . -- - - -- - for
' OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ ,
DATE / Z/ 2. 1 a
OWNER NAME: Aq (- e•t- C 0 1.4;^r.i
OWNER MAILING ADDRESS: / '(2s ‘F.4,44/t-,,J 2
J04e.7-,sfe40' A.), ft f7/
OWNER PROPERTY ADDRESS: SeiL7V AS /460 Ve:
' OWNER TELEPHONE NUMBER: 2,6,r-- /0 Y Z
TAX MAP NO. : Section 79 Block 7 Lot A)
CROSS STREET: 7flS e',E. c A
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ✓ New Existing IV'
Residential Non-Residential
- DATE OF PREVIOUS PUMP-OUT: /7c
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.)
61 4111P _1
Signat re of = pp •— •t
RECEIVED BY: GK .Cc__ .c-c�
Town C erk's O$`f'ice
DATE: RECEIVED
DEC 071987 -
Town Clerk Southold _
1
—Ss II)yg.E. s )e A Psa
0
(
a
-1C-- -0)16)/9-/D ipaluE