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OFFICE OF THE TOWN CLERK IFQ
Town of Southold 0�� : U(C��
Judith T. Terry, Town Clerkn.
Town Hall, 53095 Main Road ' �
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P. 0. Box 11794 ':
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Southold, New York 11971 �
Telephone 411Y4
(516) 765-1801 4--
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 343 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool X
NAME OF OWNER: Arthur Behrens
OWNER MAILING ADDRESS: 49 Sunset Lane
Greenport, New York 11944 •
OWNER PROPERTY ADDRESS: 49 Sunset Lane .
Greenport, New York 11944
OWNER TELEPHONE NUMBER: 516-477-0527
TAX MAP NO. : Section 33 Block 4 Lot 55
CROSS STREET: Sutton
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIQUS, PUMP-OUT: September 7.- 1985
Judith T. Terry
Southold Town Clerk
DATE: , July 15, 1987 -
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK 'S0Fetir
Town of Southold �� x �Q ' , Application No..3 yG3
Judith T. Terry, Town Clerk . € �~.f.� k"..1.:` d cey- .-� 1 Residential
Town Hall, 53095 Main Road c �
P. O. Box 1179 �' Ir.,� ► z Non-Residential
Southold, New York 11971
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Telephone44
(516) 765-1801 =01
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
• for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE 7
OWNER NAME: 4R--0714 2? A`RE/ S
OWNER MAILING ADDRESS: Set A/SE f ,4 AA(E
Er I
OWNER PROPERTY ADDRESS: 13)-
OWNER TELEPHONE NUMBER: ,574 CO? ® i ✓5 z f
TAX MAP NO. : Section 33 Block °/ Lot
CROSS STREET: e Dom, At
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool J/' New Existing
Residential L - Non-Residential
DATE OF PREVIOUS PUMP-OUT: (�4j
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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