HomeMy WebLinkAboutDonlin p 3 lye" ,t
` =' ` Town Hall, 53095 Main Road
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`�/ Ns ,�$ P.O. Box 1179
7�,�I Southold, New York 11971
JUDITH T.TERRY �I FAX(516)765-1823
TOWN CLERK
TELEPHONE(516)765-1801
REGISTRAR OF VITAL STATISTICSOFFICE 0.7:;;ITIO:CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1278-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner DONLIN, EDWIN J. AND KATHLEEN
Mailing Address 1 1825 TOWN HARBOR LANE
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 1825 TOWN HARBOR LANE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-3924
Tax Map No. section 66.00 block 1 lot 23.000
Cross Street TERRY LANE
Date Of Last Pump Out 0/00/00
Issue Date: 10/20/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
7'... • /
OFFICE OF THE TOWNi CLEFK c5IFO1L..
Town of Southold NQv _,� Application No.
Judith T. Terry, Town Clerk 014w y
°��s _C I $10.00 - Residential
Town Hall, 53095 Main Road 'syr,,,
P. O. Box 1179 cn �' '� hzi ; $25.00 - Non-Residential
Southold, New York 11971 1.34
Telephone -40j
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. i
coo- - Y3 algg
o
Fee $ 1 0
DATE PAM
'OWNER NAME: e pW l d A, 14/7 �c.J otif lei;,J •
OWNER MAILING ADDRESS: /ga( 7bWn1 14.42..#54 LAArg
S0/114•04p , N.y /i Q 71
OWNER PROPERTY ADDRESS: -/W MaW&I H4!4t1_e 2,4
S aJci
OWNER TELEPHONE NUMBER: SI(o• 76 Cr 3 ? ay-
. TAX MAP NO. : Section to Block 1 Lot /9---g
CROSS STREET: 1-"E a/ c./41. -
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing 17-
Residential
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: 1JOAJ -
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 m o Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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