HomeMy WebLinkAboutBlanchard OFFICE OF THE TOWN CLERK • .0FO[4�1,0
Town of Southold Q G
Judith T. Terry, Town Clerk � 44.#
Town Hall 53095 Main Road k
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P. O. Box 1179
Vr30'Southold, New York 11971
Telephone _ ®jJP
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 132 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: William R. Blanchard
OWNER MAILING ADDRESS: P.O. Box 43
New Suffolk. New York 11956
OWNER PROPERTY ADDRESS: 1760 Grathwohl Road
New Suffolk. New York 11956
OWNER TELEPHONE NUMBER: 516-7.34-7364
TAX MAP NO. : Section 117 Block 4 Lot 9
CROSS STREET: George Road
TYPE OF SYSTLEM: Septic Tank New Existing
Cesspool x New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: July 1986
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Judith T. Terr
Southold Town Clerk
DATE: Novembbri•7;; 1986
(TOWN SEAL) •
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OFFICE OF THE TOWN CLERK cwFFD(,(r
Town of Southold �� CQG Application No. �_9,2-,
Judith T. Terry, Town Clerk .
0.4t,347 Residential
Town Hall, 53095 Main Road
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P. O. Box 1179 u' Non-Residential
Southold, New York 11971 Oo® "-_ •O��•`
Telephone _ .(
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for - - -
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 43°2'
Fee $ ,D�
DATE 9 G\ 9,'3,\ fc
OWNER NAME: PJM: co .9) hC
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OWNER MAILING ADDRESS: Q (> <-)64 3
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OWNER PROPERTY ADDRESS: 1-1 '� �_ t�. ,� AW 1
OWNER TELEPHONE NUMBER: (51 h)
TAX MAP NO. : Section 1 /7 Block 5I Lot
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing V�
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: C ' 19 g
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 o Appli, anf
RECEIVED BY:
Town Ck's O
DATE:
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