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: Town Hall, 53095 Main Road
P.O. Box 1179
0° Southold, New York 11971
JUDITH T.TERRY r= ®� �yl��' TELEPHONE
rOWN CLERk ���� (516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 807-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner BOPP, JOHN J.
Mailing Address 1 BOX 403
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 175 MAPLE AVENUE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-8094
Tax Map No. section 140. 00 block 3 lot 24. 000
Cross Street ROUTE 25
Date Of Last Pump Out 0/00/00
Issue Date: 8/31/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
e a
OFFICE OF THE TOWN CLERK c3IFOUr -
Town of Southold O 'QQ' Application No. a_
JudithT. Terry, Town Clerk ,0 y
Town Hall, 53095 Main Road �' r "' 1 Residential
P. O. Box 1179 crs `ik vr:, 4i •
.� =�f .• •• Non-Residential
Southold, New York 11971 O O ��`
Telephone 4Q(r' f`i /i
(516) 765-1801
TOWN OF SOUTHOLD
•
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. g(),5
Fee $
/ DATE 4kyr
• OWNER NAME: J 2/f /1) I
OWNER MAILING ADDRESS:
/1,977(b
/%0 C-.1 /�y //9_s-.2
OWNER PROPERTY ADDRESS: /7c i"/l3 ,eiee
J '
1f7T/ T 4G/21
OWNER TELEPHONE NUMBER: 079$2 FU 9V
TAX MAP NO. : Section / " i Block .:-_3 Lot
CROSS STREET: T• p?S�
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool /K' New Existing X
Residential ,( Non-Residential
DATE OF PREVIOUS PUMP-OUT: fly C,q.ST ./77
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.)
Aef
//'
Si. /a"ure of Applicant
RECEIVED BY: /y-y,"/4, 1- (2_4_0a, J
- Than Clerk's Office
DATE: R`
NIG 3119 '
'law Clerk r,4,0
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