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•OFFICE OF THE TOWN CLERK •c0FOCke,,
Town of Southold �� F , 0�
Judith T. Terry, Town Clerk t ---"
Town Hall, 53095 Main Road
P. 0. Box 1179
Southold, New York 11971 �-
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Telephone _1
(516) 765-1801 - ,•-
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 184 Residential x
Fee $ 10.00 Non-Residential
Septic Cesspool x
NAME OF OWNER: Robert L. Boger
OWNER MAILING ADDRESS: Willow Point Road
Southold, New York 11971
OWNER PROPERTY ADDRESS: Willlow Point Road
Southold, New York
OWNER TELEPHONE NUMBER: 516-765-1084
TAX MAP NO. : Section 56 Block 5 Lot 77
CROSS STREET: Bay Home Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: None
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Judith T. Terry
Southold Town Clerk
DATE: December 19, 1986
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK ikirp
Town of Southold . .,),e3,,-� C'�G' , Application No. if y
Judith T. Terry, Town Clerk �`
Town Hall, 53095 Main Road c � '' s. :c l Residential
P. O. Box 1179 cn - Non-Residential
Southold, New York 11971 a" 44.4.A.;-,% - .$
•4/2,--m--,40.
Telephone : ��
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
•
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. /fY
Fee $ /O r
DATE /�
OWNER NAME: 0 �7--- L e
OWNER MAILING, ADDRESS: 614/4-1-,e ''-----Fr , 0 °_D
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OWNER PROPERTY ADDRESS: 97'fi' 1----
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OWNER TELEPHONE NUMBER: 2 6 f---/dr
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TAX MAP NO. : Section 6-6 Block S Lot 02 7
CROSS STREET: v S ?U1 `p 477e---- k3c,.44 idernuL, ed
0 /TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential 17 Non-Residential
DATE OF PREVIOUS PUMP-OUT: 471/
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 BYqC �� /' /� 'G
\Tow Clei•k's Office
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DATE: /9 // ,-1', i
P Cr rtv m
DEC 19 1996
Town Clerk Southold .
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