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OFFICE OF THE TOWN CLERK c f 'r ' {--
Town of Southold
Judith T. Terry, Town
y Clerk 17,
Town Hall, 53095 Main Road
P. 0. Box 1179 ' u wr 11.44.0
Southold, New York 11971 7 �� , .• ' �-
Telephone _19/ �
(516) 765-1801 L`
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 585 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: Charles and Rosemarie Crofts
OWNER MAILING ADDRESS: 2015 Stillwater Avenue
Cutchogue. New York 11915
OWNER PROPERTY ADDRESS: 2015. Stillwater Avenue
Cutchogue, New York
OWNER TELEPHONE NUMBER: 516-734-7344
TAX MAP NO. : Section 103 Block 8 Lot q
CROSS STREET: Willow Street _
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
Judith T. erry
Southold. Town Clerk
DATE: Janaury 26. 1988
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK F
Town of Southold � C®�',, Application No. �S
Judith T. Terry, Town Clerk
r 1 Residential
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Town Hall, 53095 Main Road � .. �'_� -
P. O. Box 1179 : Non-Residential
Southold, New York 11971 %xo5cza;-W* ,
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Telephone ®1 d�a
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
- for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE
OWNER NAME: (101A—ES �/ ,90/5 L%/e8:9F7
OWNER MAILING ADDRESS: ‘ 677,5"---57-76 C 1,0 7Z€ b'S
Cur e9�vc� � //93S-'
OWNER PROPERTY ADDRESS: �1::
OWNER TELEPHONE NUMBER: (57o) 73 T 73% L
TAX MAP NO. : Section /03 Block B Lot
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
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.)
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Signature of Applica
RECEIVED BY: czG„ Q,
Townr/Clerk' Office
DATE:
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