HomeMy WebLinkAboutDonahue `t F P''k Town Hall, 53095 Main Road
� �r P.O. Box 1179
Tt,q,„9 �' Southold, New York 11971
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JUDITH T.TERRY =- � �s' TELEPHONE
TOWN CLERK (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. 779-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner DONAHUE, FRANCIS C.
Mailing Address 1 7750 HORTON LANE
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 7750 HORTON LANE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-1039
Tax Map No. section 54.00 block 1 lot 28 .000
Cross Street MAJORS PATH
Date Of Last Pump Out 0/00/78
Issue Date: 8/08/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK
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Town of Southold �� 5 . CD = Application No. �/
Judith T. Terry, Town Clerk 4. w - Vis;
53095 Main Road -< 7 Residential
Town Hall, 'Yr ,
p, O. Box 1179 .:� . :�.,;. �� Non-Residential
Southold, New York 11971 .J
Telephone /Et �► •
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for - -
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
• DATE
OWNER NAME: fe�j3,d- 5 C'_ ,J7(O Al 444
OWNER MAILING ADDRESS: "° J E a / To )`
OWNER PROPERTY ADDRESS: l'h
OWNER TELEPHONE NUMBER: � 163 9
TAX MAP NO. : Section 3-y Block / Lot
CROSS STREET: //ris6In Pal- 4
TYPE OF SYSTEM: Septic Tank New t/ Existing
Cesspool New Existing
Residential L— Non-Residential
DATE OF PREVIOUS PUMP-OUT: / 5 71
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.)
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Signature of Applicant
RECEIVED B ! <e :.► -4► • -
Town f Jerk's Of ice
DATE:
AUG 08
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