HomeMy WebLinkAboutDoherty JUDITH T. TERRY �' Town Hall, 53095 Main Road
TOWN CLERK ® P.O.r�r, Box 1179
el9 Southold, New York 11971
REGISTRAR OF VITAL STATISTICS = aY® �� Fax (516) 765-1823
MARRIAGE OFFICER �/'/ �® ,�� Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER -=7® *
FREEDOM OF INFORMATION OFFICER ����iiiliri/i�
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3158-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner DOHERTY, JOSEPH AND VIRGINIA
Mailing Address 1 780 WESTVIEW DRIVE
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 780 WESTVIEW DRIVE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-5052
Tax Map No. section 139.00 block 1 lot 16.000
Cross Street BROWER ROAD
Issue Date: 12/22/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
se
OFFICE OF THE TOWN CLERK cvFFOUr 3 ` ��/
Town of Southold - CQG' , Application No.
Judith T. Terry, Town Clerk . ' ;
gy" �G `i $10.00 - Residential
Town Hall, 53095 Main Road a �r
P. O. Box 1179 u' _ _ ' �':' ' . $25.00 - Non-Residential
Southold, New York 11971 O
•
Telephone "4-'44-0,
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLi CAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3/S-e'
Fee $ 10 .--
DATE V.? 3
OWNER NAME: °foe* /In itG-/1w At- b ,VTY
OWNER MAILING ADDRESS: 78-0 LAMP T frYEL(/ O 4'
'r-n r v c.J. A/y « 9v-z.
OWNER PROPERTY ADDRESS: s *Met
OWNER TELEPHONE NUMBER: 25 - S17 f
TAX MAP NO. : Section /3 Block / Lot /
CROSS STREET: j1,� 00(
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool 104°.r New Existing
Residential Non-Residential
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.)
i cg 44,
ignature of Applicant
RECEIVED BY:
Town C erk's Office
DATE: / DL--/2--/AZ)
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