HomeMy WebLinkAboutBarra OFFICE OF THE TOWN CLERK ' c5191(x`;
Town of Southold OG
Judith T. Terry, Town Clerk •Z -
Town Hall, 53095 Main Road o _' ;
P. O. Box 1179 t
Southold, New York 11971 ��� ;`
Telephone =01 [
(516) 765-1801 .-•
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL -DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 209 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool X
NAME OF OWNER: Edith G. Barra
OWNER MAILING ADDRESS: Box 81
Orient, New YOrk 11957
OWNER PROPERTY ADDRESS: 475 Orchard Street
Orient, New York
OWNER TELEPHONE NUMBER: 516-323-2423
TAX MAP NO. : Section 25 Block 7 Lot 20.13
CROSS STREET: Navy Street
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
Judith T. Ter
Southold Town Clerk •
DATE: February 3, 1987
(TOWN SEAL)
OFFICE OF THE TOWN CLERK VFO(A- -
Judith
TTW Terryof �uTown Clerk \O- "�� ���: Applicationc�E�
tholdNo
Town Hall, 53095 Main Roadgt 7 Residential c�
P. 0. Box 1179 cr3 "1141-`' *-$ Non-Residential
Southold, New York 11971 O • { � * ,�
$
Telephone �l ,
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
•
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee_ $ /OcPt'
DATE --/ -/ ? 7
OWNER NAME: G !elr + 7314&-44
OWNER MAILING ADDRESS: 'BO CitfevA',ye 195 ?
OWNER PROPERTY ADDRESS: x05 Olt-644a S°Fie_ _f
OWNER TELEPHONE NUMBER: 3 Z f 2-
�� Block Lot - /3
TAX MAP NO. : Section
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: if/1//440ccm1
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.)
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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