HomeMy WebLinkAboutCoutts (2) OFFICE OF THE TOWN CLERK ���0(,��•
Town of �Southold , 0��� 4
Judith T. Terry, Town Clerk ,47, pk "
Town Hall, 53095 Main Road ;�;%
P. O. Box 1179 tri r, W' n
Southold New York 11971 '. ` �cF �- „
Telephone '1%(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 366 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: Walter and Margaret Coutts
OWNER MAILING ADDRESS: 365 Cedar Drive
Mattituck, New York 11952
OWNER PROPERTY ADDRESS: 365 Cedar Drive
Mattituck, New York 11952
OWNER TELEPHONE NUMBER: 516-298-8118
TAX MAP NO. : Section 106 Block 11 Lot 4
CROSS STREET: Bayview Avenue
" TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: 1960
Judith T. Terry
Southold Town Clerk
DATE; July 29, 1987
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK SFFO( �-"
Town of Southold - C Application No. 36h
Judith T. Terry, Town Clerk .; • {� •
Town Hall, 53095 Main Road o ! Residential
P. 0. Box 1179 `` ' ; Non-Residential
Southold, New York 11971 O ®,
Ot-
.
Telephone ®( , •�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /04 &G'
DATE 7 //01x7
OWNER NAME: A-L`t 1 '4ft-AR
OWNER MAILING ADDRESS 4J re.:-0,l5--l4 0/V,.
/ Ir I G 'C-/ _//F
OWNER PROPERTY ADDRESS: �y
OWNER TELEPHONE NUMBER:..,R7
TAX MAP NO. : Section Block , Lot - ,
CROSS STREE
)01)
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing,°)
Residential X— Non-Residential
DATE OF PREVIOUS PUMP-OUT: • /" r /76"0
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 of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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