HomeMy WebLinkAboutAgria (2) OFFICE OF THE TOWN CLERK 6 c51 ()Uri)),
Town of Southold �
Judith T. Terry, Town Clerk . k� y1 ,
Town Hall, 53095 Main Road a 1 V i
P. O. Box 1179 qtr -< 'r! ' " �
Southold, New York 11971 pOa&
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Telephone ?t -ism
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 386 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: John Agria - ----
OWNER MAILING ADDRESS: Wells Road -
Peconic, New York 11958
OWNER PROPERTY ADDRESS: Wells Road
Peconc, New York
OWNER TELEPHONE NUMBER: 516-765-3313
TAX MAP NO. : Section 86 Block 1 Lot 17
CROSS STREET: Main Road
TYPE OF SYSTEM: Septic Tank New Existing.
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: June 5 1 '87
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Southold Town Cliftk
DATE: August 5, 1987
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\ (TOWN SEAL)
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OFFICE OF THE TOWN CLERK \FMir
Town of Southold Application No.3
Judith T. Terry, Town Clerk - ±r
Town Hall, 53095 Main Road a y . ' Residential
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P. O. Box 1179 � �-` � Non-Residential
Southold, New York 11971 uN- "`:� • S
Telephone Telephone _ A 's•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3
617
Fee $ /0
• DATE
OWNER NAME: John Agria
OWNER MAILING ADDRESS: Wells Road = Peconic , N.Y. 11958
OWNER PROPERTY ADDRESS: Wells Road = Peconic , N.Y.
OWNER TELEPHONE NUMBER: 765-3313
TAX MAP NO. : Section "36 Block / Lot /2.
CROSS STREET: 4,/�
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: June 5, 1987
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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Ja.ignature fr3plicant
RECEIVED BY:
Town CI 's OffiRECEIM
DATE:
m 1
Town Clerk Southold
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