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HomeMy WebLinkAboutBasso OFFICE OF THE TOWN CLERK Town of Southold 0� Judith T. Terry, Town Clerk Town Hall, 53095 Main Road AP. 0. Box 1179 cry 'rtelrir4 Southold, New York 11971 � `- Telephone ®1 � (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 561 Residential x Non-Residential Fee $ 10.00 Septic Cesspool x NAME OF OWNER: John and Edna Basso OWNER MAILING ADDRESS: Oak Drive, RR 1 . Box 64E Cutchogue. New York 11935 OWNER PROPERTY ADDRESS: Oak Drive Cutchogue. New York OWNER TELEPHONE NUMBER: 516-734-5839 TAX MAP NO. : Section 104 Block 5 Lot 28 CROSS STREET: Broadwaters Drive TYPE OF SYSTEM: Septic Tank New Existing Cesspool x New Existing x Residential x Non-Residential DATE OF PREVIOUS PUMP-OUT: 1981 Judith T. Terry Southold Town Clerk DATE: January 8, 1988 } (TOWN SEAL) ,, • •i.ii OFFICE OF THE TOWN CLERK C, FO(A' Town of Southold �d µ Application No. Judith T. Terry, Town Clerk ' 'v4r --ATown Hall, 53095 Main Road o tz } Residential P. O. Box 1179 ' � �: Non-Residential Southold, New York 11971 ® � �►` Telephone '7701 '6\ (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for - OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ ( D , `o DATE OWNER NAME: G. )4K‘i ( D '1/ A 1 (4 55 0 OWNER MAILING ADDRESS: ©A iC D , ► 3 X y i nyr, 6`toCc/ �' r i y, l / % 36 OWNER PROPERTY ADDRESS : OWNER TELEPHONE NUMBER: 7 j L/— 5-F3 ci TAX MAP NO. : Section / b 7 Block Lot CROSS STREET: 04 K e d G . t • TYPE OF SYSTEM: Septic Tank New Existing Cesspool New Existing X Residential X Non-Residential DATE OF PREVIOUS PUMP-OUT: `'e1 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 CE,t<.: Tow( Clerk's Office JAN 06 1987 DATE: Tnvo Curl{ Southokt 9 •