HomeMy WebLinkAboutDillon 104 �,
� .fa "' "�;;,��;;*�; -7k-- ` Town Hall, 53095 Main Road
{' P.O.Box 1179
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:t,.:: , f• Southold,New York 11971
JUDITH T.TERRY tl' � s� FAX(516)765-1823
TOWN CLERK `l'omoi"iti TELEPHONE(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. 1352-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner DILLON, DONALD
Mailing Address 1 366 BROADWAY, APT. 2C
Mailing Address 2
City St Zip NEW YORK CITY, NY 10013-0000
Property Address 1 870 BAY AVENUE
Property Address 2
City St Zip MATTITUCK, NY 11952-0000
Owner Telephone No. 212-233-6799
Tax Map No. section I 3 bloock 3 -
lot 15.000
Cross Street RILEY AVENUE
Date Of Last Pump Out 3/11/87
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Issue Date: 12/6/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK tc;�FFO(,rr�'C'-
Town of Southold Application No. /...Val.
Judith T. Terry, Town -Clerk ` yo K y
Town Hall, 53095 Main Road �, $10.00 - Residential
Pd1 �; t"
P. O. Box 1179 q - i
.-��' � $25.00 - Non-Residential
Southold, New York 11971 O ® 00.�`
Telephone 041% '
(516) 765-1801
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for .._
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3 S�
Fee $ / 4. be'
DATE2/w/91
OWNER NAME: Do/up-bp T)/ LJ-DrJ
OWNER MAILING ADDRESS: ` 'Af> ;411Apktavy . 2 • h
e �°IP
OWNER PROPERTY A.DD ESS• l; W
tae �
y
Ivey 1.
OWNER TELEPHONE NUMBER: (1,A7.7) 153-(41a)6t,c) 4i) o7(o-O (FI )
TAX MAP NO. : Section 1115,00 Block 63.00 Lot CO'', #00
CROSS STREET:
TYPE OF SYSTEM: Septic Tank _ New Existing
Cesspool tscJew Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: 1//2.1181 3/8/I - v •1 04914,-1211i1S(o
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.)
t likit
Signature of Applicant
RECEIVED BY: 44,111111`,,c4„
" .wn P Jerk' Office
DATE: /0671
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