HomeMy WebLinkAboutCrawford OFFICE OF THE TOWN CLERK ' •c�vFFO( r
Town of Southold �� CDG
Judith T. Terry, Town Clerk ttf
Town Hall, 53095 Main Road a
P. 0. Box 1179 ;cn
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Southold, New -York 11971 j �
Telephone '�( ^ '‘N
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 69 Residential XX
Non-Residential
Fee $ 10.00
Septic Cesspool XX
NAME OF OWNER: Dorothy S. Crawford & Ano.
OWNER MAILING ADDRESS: 3 Hillcrest Drive
Randolph, New Jersey 07869
OWNER PROPERTY :ADDRESS: -610-Clark--Road
Greenport, New York
OWNER TELEPHONE NUMBER: 201-366-0711,
TAX MAP NO. : Section 135 Block 2 Lot 2
CROSS STREET: Soundview Avenue
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool XXX New Existing XXX
Residential XXX Non-Residential
DATE OF PREVIOUS PUMP-OUT: April 1985
0.0960.:
Judith T. Terr
Southold Town Clerk
DATE: September 24, 1986
(TOWN SEAL) -
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OFFICE OF THE TOWN CLERK CSFOCA- -
Town of Southold �® re "' Application No. �,9
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road o '`2" ` - "'-t :'4 Residential �
P. O. Box 1179
un k '�"� �i !' Non-Residential
Southold, New York 11971 ® fir. �`
Telephone -.7_(// y
(516) 765-1801
RECE6VED TOWN OF SOUTHOLD
SEP 1 7 19$6 SOUTHOLD WASTEWATER DISPOSAL DISTRICT
Town Clerk Southold APPLICATION
RECEIVES for
sEp 241986 OPERATION PERMIT
Town Clerk Southold SEPTIC TANK or CESSPOOL
Operation Permit No. 7
Fee $J-0
DATE Sep- I � -. I J gG
OWNER NAME: G -j I-}- `C Cga vQFc PT e /4 i.u.
OWNER MAILING ADDRESS: /) 1LtC2EST-- DR,
,1-N CI ) /-/- , /V-- -- 07W
OWNER PROPERTY ADDRESS: (Di O C L /j12K RD
S O U L 4 c c ). )by( ) ) "?
OWNER TELEPHONE NUMBER: ( 2..o l-) GC, — 0"--) / /
TAX MAP NO. : Section 1 OO p- 3�� Block 2 '-> Lot --z—
CROSS STREET: _SOU NDSU/ f`;.\ F'-VL
TYPE OF SYSTEM: Septic Tank ')( New Existing
Cesspool '�C New Existing x
Residential ` < Non-Residential
DATE OF PREVIOUS PUMP-OUT: PR) L ) 9
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.)
4, -7-,
Sj.nature of A plicant
RECEIVED BY: a "-xzVeL, Q0,6_6_00.,e ),
Town Ci(erk's Office
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