HomeMy WebLinkAboutAnderson OFFICE OF THE TOWN CLERK ic,OFOUrc0
Town of Southold � G • .
Judith T. Terry, Town Clerk Oltfr_ —�
Town Hall, 53095 Main Road z ,
P. O. Box 1179
Southold, New York 11971 p ® "-3 •%
Telephone �.( a
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
•
SEPTIC TANK or CESSPOOL
Operation Permit No. 305 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool X
NAME OF OWNER: James T. Anderson ,
OWNER MAILING ADDRESS: P.O. Box 741
Mattituck, New York 11952
OWNER PROPERTY ADDRESS: 165 Freeman Road
Mattituck, New York 11952
OWNER TELEPHONE NUMBER: 516-298-8278
TAX MAP NO. : Section 139 Block 3 Lot 36
•
CROSS STREET: Wickham Avenue and Grand Avenue
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New - Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: 1 /5/87
Judith T. Terry
Southold Town Clerk
DATE: May 18, 1987
(TOWN SEAL) •
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OFFICE OF THE TOWN CLERK 'c��FFD(," " ,.."`
Town of Southold % CQ = Application No. (3Q 5r
Qom.,'. " , G
Judith T. Terry, Town Clerk i,.,: 1
Town Hall 53095 Main Road
f �C Residential
p. O. Box 1179 Li" t` x�-, f Non-Residential _:
Southold, New York 11971 O ®�``w0el`
Telephone _®.( Y, ��
0'
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for '
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.3O( "
Fee $ 10 .•00
DATE April 24 , 1987
OWNER NAME: James T. Anderson
OWNER MAILING ADDRESS: P. 0. Box 741 -
Mattituck, N.Y. 11952
OWNER PROPERTY ADDRESS: 165 Freeman Road, Mattituck NY
OWNER TELEPHONE NUMBER: 298-8278'
TAX MAP NO. : Section 139 Block 3 Lot 36
CROSS STREET: Wickham Ave & Grand Ave
TYPE OF SYSTEM: Septic Tank •, New Existing L
Cesspool X New Existing X
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: 1/5/87
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.)
641-A-7"'")
vv, �
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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SURVEY FOR - • -
= JAMES ANDERSON a JANET ANDERSON
PART OF LOTS'41642,MAP OF GARDEN-HER
- MATXI TUCK
TOWN OF SOUTHOLD - - -
SUFF. ' CO., N. Y. 6UAR'ANTEED TO:
FARMERS HOME ADMINISTR!
,= ± NOTE �� _ MOMS TITLE DIVISION OF t
' ' PI s MONUMENT FOUND SCALE = - III = 40 TITLE-INSURANCE COMPAN
: ., a' -� s x MONUMENT PLACED -
- • =; - SUBDIVISION MAP FILED :IN THE NOV. 22, 1968 7.- `r NOV. 6, 1969'
• ,• • OFFICE OF THE CLERK OF SUFFOLK
COUNTY ON JUNE 24,1929 AS MAP N0.577 - PROFESSI NGIN I
LAND SUR VEYON.Y.S. C.N
-
RIVERHEA 0.-N.Y.