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_ OFFICE OF THE TOWN CLERK ' 14WrQ(k
Town of Southold , 0�� , CDG
Judith T. Terry, Town Clerk Z`
Town Hall, 53095 Main Road g ."x}
P. O. Box 1179 1 to
Southold, New York 11971 ,O 0*.$
Telephone _ 0,( .14 $►6 '°
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 75 Residential xx
Fee $ Non-Residential
10.00
Septic Cesspool xx
NAME OF OWNER: Donald and Kathryn Boyle
OWNER MAILING ADDRESS: 13 Hoffman Street
Maplewood, New Jersey 07040
OWNER PROPERTY ADDRESS: Camp Mineola Road
Mattituck, New York 11952
OWNER TELEPHONE NUMBER: 201-761-1029
TAX MAP NO. : Section 123.. Block 5 Lot 4
CROSS STREET: Reeve Avenue
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool Kg New Existing XX
Residential %X Non-Residential
DATE OF PREVIOUS PUMP-OUT: June 1985
O� •
Judith T. Terr
Southold Town Clerk
•
DATE: September 30, 1986
(TOWN SEAL) •
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OFFICE OF THE TOWN CLERK ec0Fair
Town of Southold �� r� - CQ Application No. �`5
Judith T. Terry, Town Clerk , '.115:%‘'\
Town Hall, 53095 Main Road .74 Residential
P. O. Box 1179 cn � : �` Non-Residential
Southold, New York 11971 O •�, t `
Telephone O ,Tx.
(516) 765-1801
REeRIVM TOWN OF SOUTHOLD
SEP 3 O 1986 SOUTHOLD WASTEWATER DISPOSAL DISTRICT
Town C'erk Southold
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 9,r
Fee $ A9
•
DATE (���' 6
f
OWNER NAME: 2)04Mg 7--/74y/) oyc.E
OWNER MAILING ADDRESS: /3 �F`i�/1--J Sr
'-7'9P4-•.=W O o ) T 0-70Y0
OWNER PROPERTY ADDRESS: ,2 a ,
�19 77-/ 7z/e/ // �Z
OWNER TELEPHONE NUMBER: 9o/ 26/ /o2 7
1 �
TAX MAP NO. : Section /2.. g Block Lot
CROSS STREET: i?ecv 6- A ✓t5/-
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residentia )( Non-Residential
DATE OF PREVIOUS PUMP-OUT: - - -'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.)
Signature of Appicant
RECEIVED BY:
Town Clk's Of
DATE: lar-C.
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