HomeMy WebLinkAboutBecker OFFICE OF THE TOWN CLERK cOffiLA-e,"
Town of Southold
Judith T. Terry, Town ClerkIZZ; •
Town Hall, 53095 Main Road
P. 0. Box 1179 t14atzjSouthold, New York 11971 . •
TelephoneO01
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 360 Residential X
Fee $
10.00 1 Non-Residential
Septic Cesspool,` X
NAME OF OWNER: John H. & Rebecca J. Becker
OWNER MAILING ADDRESS: Box 368 N. Bayview Road
Southold, N.Y. 11971
OWNER PROPERTY ADDRESS: N. Bayview Rd.
Southold, N.Y. 11971
OWNER TELEPHONE NUMBER: (516) 765-5650
TAX MAP NO. : Section 79 Block 3 Lot 14
'CROSS STREET: Jacob's Lane
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TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
iResidential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: May 12, 1987
{ Judith T. Terry
Southold Town Clerk
DATE: July 23, 1987
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK S��FfJI, • -_
Town of Southold �� CV , Application No. cag.4t,tr
Judith T. Terry, Town Clerk ' : , /
F., rt 1 1 Residential V
Town Hall, 53095 Main Road .
P. O. Box 1179 �' z :yam.' art ; Non-Residential
Southold, New York 11971 O `� `•
Telephone ( * %1\:6‘:,
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. ,3;6ey'
Fee $ ` O. pp
DATE
OWNER NAME: T o /1/4v A/ v'— /c ebeec q •• /3 Fe
OWNER MAILING ADDRESS: ,f3 367 A/.• /3)c7 drew �D,
6av14oAD Ai •y /19,71
OWNER PROPERTY ADDRESS: Aj/_ R,y/,/decrJ, ,e®,
s cry 2 4'o.Z. 2 .,v.
OWNER TELEPHONE NUMBER: 6!/6' )
TAX MAP NO. : Section Block ,3 Lot /9
CROSS STREET: a ooS L r
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ?/ New Existing 17
Residential a/ Non-Residential
DATE OF PREVIOUS PUMP-OUT: ?7
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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Sita ure of Applicant
RECEIVED BY: -49// , /11—e .
• n ler Office
DATE: 7/42-1/7
JOHN H. BECKER
P. O. BOX 368
N. BAYVIEW RD.
SOUTHOLD, NEW YORK 11971
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