HomeMy WebLinkAboutDermody s �; . i Town Hall, 53095 Main Road
y ; .w�` P.O. Box 1179
`0 1_ "�� '/ Southold, New York 11971
JUDITH T.TERRY _®� ��1�� TELEPHONE
TOWN CLERK ,'....wiiIl (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. 786-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner DERMODY, NANCY
Mailing Address 1 285 ALVAHS ALNE
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 285 ALVAHS LANE
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-5349
Tax Map No. section 109. 00 block 1 lot 32. 000
Cross Street ROUTE 25
Date Of Last Pump Out 0/00/78
Issue Date: 8/12/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
• iii'I
OFFICE OF THE TOWN CLERK r�qH `7 °
Town of Southold C'0 Application No.
Judith T. Terry, Town Clerk 0 ,•Vtrn -0
" .�° , c �c 1 Residential
n
Town Hall, 53095 Main Road � ;� .
P. O. Box 1179 cr .
,.f .. Non-Residential
Southold, New York 11971 �
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
•
APPLICATION
for
Vim
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. ---7e6
Fee $ /D
DATE
OWNER NAME: Na +5lief-ma+
OWNER MAILING ADDRESS: / i-5 _
Cr, c 0 L e-e 4/ U /f do
OWNER PROPERTY ADDRESS: . ,4.5 ahp2,-�
OWNER TELEPHONE NUMBER: 6j7€) 7-3- Z-• v`3
TAX MAP NO. : Section /0? Block / Lot 3 •
CROSS STREET: 67
TYPE OF SYSTEM: Septic Tank New • Existing
Cesspool L/ New Existing t7
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: ! 9 7
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.)
. . / 42•yr2 ::
'.nature of Applicant
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RECEIVED B r vJ( / C_.,
(jrcvaf5CJkrk's Office.
DATE: C 12 1238
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