HomeMy WebLinkAboutBarnett OFFICE OF THE TOWN CLERK $ c_�MiLk
Town of Southold
Judith T. Terry, Town Clerk � aJ }'-., '
Town Hall, 53095 Main Road _ `-iT rr-sem '
P. O.
Box 1179 •=-� .y�,Y=� �
Southold, New York 11971 `^pis, •
Telephone .( s-'0
• (516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 92 Residential XX
Non-Residential
Fee $ 10.00
Septic Cesspool XX
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NAME OF OWNER: Louis B. Barnett
OWNER MAILING ADDRESS: P.O. Box 596
Southold, New York 11971
OWNER PROPERTY ADDRESS: 54755 MainRoad
Southold k New York
OWNER TELEPHONE NUMBER: 516-765-3955
TAX MAP NO. : Section 63 Block 3 Lot 21 .3
CROSS STREET: Boisseay Avenue
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool XX New Existing XX
Residential XX Non-Residential
DATE OF PREVIOUS PUMP-OUT: September 1 , 1986
ereetoefoes
ver
Judith T. Te y
Southold Town Clerk
DATE: October 16, 1986
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(TOWN SEAL) �1• _.
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OFFICE OF THE TOWN CLERK scOF(It
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Town of Southold ff® , CQG'� Application No. 9,2
Judith T. Terry, Town Clerk •'
Town Hall, 53095 Main Road �, - Y : ` Residential
P. O. Box 1179 cn Non-Residential
Southold, New York 11971 ON#V,4"qF
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
OCT
58 SOUTHOLD WASTEWATER DISPOSAL DISTRICT
Twirl CLr i( SO+°fhOld
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /D
DATE October 15.; 1986
OWNER NAME: Louis B. Barnett
OWNER MAILING ADDRESS: P.O. Box 596
Southold, New York 11971
OWNER PROPERTY ADDRESS: 54755 Main Road •
Southold, New York 11971
OWNER TELEPHONE NUMBER: (516) 765-3955
TAX MAP NO. : Section 6 3 Block 3 Lot 0.2/• 3
CROSS STREET: BO(.--SS EAU -A)
TYPE OF SYSTEM: Septic Tank V New Existing x/
Cesspool New Existing x'
Residential 4 Non-Residential
DATE OF PREVIOUS PUMP-OUT: September 1 , 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.)
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Signature of Applicant
RECEIVED BY:
7j
Town lerk'sOffice
DATE: d- O—L-cAj / , //
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