HomeMy WebLinkAboutAndrade OFFICE OF THE TOWN CLERK ' G��FFO(x`," '
Town of Southold � �G
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road
P. O. Box 1179 % cn
Southold, New York 11971 ;0 e��,
Telephone Nte. to
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 35 - Residential Xx
Non-Residential
Fee $ 10.00 _
Septic Cesspool xx
NAME OF OWNER: - Lorraine and JeffDey Andrade
OWNER MAILING ADDRESS: P.O. Box 1017
Mattituck, New York 11952
OWNER PROPERTY- ADDRESS: Meday Avenue
Mattituck, New York 11952
OWNER TELEPHONE NUMBER: 516-298-5104
TAX MAP NO. : Section 113 Block S Lot 1 9
CROSS STREET: Cox Neck
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool xx New Existing xx
Residential %X Non-Residential
DATE OF PREVIOUS PUMP-OUT: July 1986
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Judith T. Terry
Southold Town Clerk
DATE: September 2, 1986
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OFFICE OF THE TOWN CLERK COMA'
Town of SoutholdC�, Application No. 2S
Judith T. Terry, Town- Clerk 4A � rte-'
Town Hall, 53095 Main Road Y Residential
P. O. Box 1179 � �� .`' Non-Residential
Southold, New York 11971 0,x,. _ `aOZ- ••'
Telephone : 1 �►
kr
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3S
Fee $ 10 . 0 0
DATE August 28 , 1986
OWNER NAME: Lorraine Ej Jeffrey Andrade
OWNER MAILING ADDRESS: Meday Avenue, P .O. Box 1017
Mattituck, NY 11952
- - OWNER PROPERTY ADDRESS: --
OWNER TELEPHONE NUMBER: 298-5104
TAX MAP NO. : Section 3 Block g Lot /
CROSS STREET: COX NECK
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: July 1986
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.)
Aft-z4oce.,x,e 6 . a-n6(4,_,06--
Signature of Applicant
RECEIVED BY: c(,,�
Town QLlerk's Office
DATE:
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