HomeMy WebLinkAboutBradley OFFICE OF THE TOWN CLERK • icOFO(/r`,"
Town of Southold Q . Olj
Judith T. Terry, Town Clerk 1y ,
Town Hall, 53095 Main Road oto A yr
P. 0. Box 1179 to - �'z .'
Southold, New York 11971 ' p ® .4*"'
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Telephone -70/ 11(
(516) 765-1801
TOWN OFSOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 451 Residential X
Non-Residential
•
Fee $ 10.00
Septic Cesspool X
NAME OF OWNER: Eugene Bradley
OWNER MAILING ADDRESS: 310 Stillwater Avenue
Cutchogue, New York 11935
OWNER PROPERTY ADDRESS: 310 Stillwater Avenue
Cutchogue, New York
OWNER TELEPHONE NUMBER: 516-734-7131 •
TAX MAP NO. : Section 103 Block 7 Lot2
CROSS STREET: Main Road (Route 251
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
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Judith T. T ry
Southold Town Clerk
DATE: September 30, 1987
(TOWN SEAL)
I III
OFFICE OF THE TOWN CLERKFULA- '-
Town of Southold %c31 C& ' , Application Noi5i
Judith T. Terry, Town Clerk
Town Hall 53095 Main Road a . � ,+ �G Residential
P. O. Box 1179 v' ' 7 ��� Non-Residential
Southold, New York 11971 ® �`,- ��
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
FU F'
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /c , /a
DATE Y/36/1) 7
OWNER NAME: v ���� "9,2
OWNER MAILING ADDRESS: �/a �Tili,iT�.�' ✓f=
�Jy� /
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: 7,3/7/3/
TAX MAP NO. : Section /( ` Block Lot 2,
CROSS STREET: /i.// ,9 O /77: 7'S-
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool r New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: [//t/('>ria'Gv' n/
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.)
Signatu - of Applic
RECEIVED BY •
ficrt r:"R1LLwn Ierk's Office
DATE: ','•7
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