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OFFICE OF THE TOWN CLERK • '��FFp(K .,
Town of Southold
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Judith T. Terry, Town Clerk '
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Town Hall, 53095 Main Road rte`
P. O. Box 1179 Era , �
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Southold, New York 11971 �p ;® ��"w."O�$
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 81 Residential XX
Fee $ 10.00 Non-Residential
Septic Cesspool xx
NAME OF OWNER: Gertrude F. Bowden
OWNER MAILING ADDRESS: P.O. Box 132
New Suffolk, New York 11956
OWNER PROPERTY ADDRESS: Wicks Road
New Suffolk, New York
OWNER TELEPHONE NUMBER: 516-734-6777
TAX MAP NO. : Section 110 Block 8 Lot
CROSS STREET: Grathwohl Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool XX New Existing xx
Residential xx Non-Residential
DATE OF PREVIOUS PUMP-OUT: July 8, 1986
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Judith T. Terr
Southold Town Clerk
DATE: October 6, 1986
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK �COW0,„„=
Town of Southold Application No. er
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road oolk," 7 Residential
P. O. Box 1179 cn �' Non-Residential
Southold, New York 11971 O ® "
Telephone = .�
(516) 765-1801
RECF_IIPM TOWN OF SOUTHOLD
OCT O 1986 SOUTHOLD WASTEWATER DISPOSAL DISTRICT
• 3uathold'
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ 416
DATE /61/4// r
OWNER NAME: ele- 12U d
OWNER MAILING ADDRESS: C 1(s ,ct Z /1/ 0/SUFP®41!
LOd
l/93 6
OWNER PROPERTY ADDRESS: tj/.0/ S /6d 2)
OWNER TELEPHONE NUMBER: /‘ - . 73V ,_‘ 77 7
TAX MAP NO. : Sectio // O Block e57 Lot 3
CROSS STREET: e /--�
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool / New Existing !
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: 7/ ,/ e /
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.)
esseId.4.,
/1s_oF
/-/vus Signature of Applicant
RECEIVED BY:
Town C6'erk's Of ice
DATE: , /SX,