HomeMy WebLinkAboutAgria OFFICE OF THE TOWN CLERK e! ' FQ
Town of Southold ��� Cey
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road A tx.11
P. 0. Box 1179 �� #_,xu
Southold, New York 11971 p .'
Telephone _ 1
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 282 - Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool X
NAME OF OWNER: John J. Aqria
OWNER MAILING ADDRESS: 56 Chambers Avenue
Greenville, PA 16125
OWNER PROPERTY ADDRESS: 52340 Main Road
Southold, New York 11971
OWNER TELEPHONE NUMBER: 412-588-1464
TAX MAP NO. : Section 63 Block 6 Lot 9
CROSS STREET: Oakland
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT:
a I Jr-404; #427
Judith T. Terry
Southold Town Clerk
DATE: April 22; 1987
(TOWN SEAL)
OFFICE OF THE TOWN CLERK �e_gFOtir
Town of Southold � CQ Application No.c2r
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road Residential
�
P. O. Box 1179 to 1.-1-. y ' ` --Non-Residential
Southold, New York 11971
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /0'00
DATE 7
OWNER NAME: .3-i) it 75-: Aty. O�
OWNER MAILING ADDRESS: 56 C4i M 6-ec Ave
neere i% tie P4-/6 Air
OWNER PROPERTY ADDRESS: s2,-3 4 o main Yv •
Soc/Tho edJ ►11. (e. 1 Q�1�
OWNER TELEPHONE NUMBER: J(2.) 5-8%
TAX MAP NO. : Section 06,2 • 06 Block (96 • a0 Lot 06 q, 000
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: —6 —Se7
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.)
i
f.ignat ;re of A.plicant
RECEIVED BY:
Town Clerk's Office
DATE:
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