HomeMy WebLinkAboutDooley OFFOUr
JUDITH T.TERRY �� 1.4 Town Hall, 53095 Main Road
TOWN CLERK ; y P.O. Box 1179
�t Southold,New York 11971
REGISTRAR OF VITAL STATISTICS :�®� ��•1Fax(516) 765-1823
MARRIAGE OFFICER �_ ` Na‘..".•1‘
� Telephone (516) 765-1800
RECORDS MANAGEMENT OFFICER 1•„1.1
FREEDOM OF INFORMATION OFFICER ��„ ,.••
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3394-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner DOOLEY, JOHN S. AND MARIA V.
Mailing Address 1 P. O. BOX 161
Mailing Address 2
City St Zip EAST MARION NY 11939-0000
Property Address 1 2165 THE LONG WAY
Property Address 2
City St Zip EAST MARION NY 11939-0000
Owner Telephone No. 516-477-2420
Tax Map No. section 30.00 block 2 lot 12.000
Cross Street THE SHORT LANE
Issue Date: 10/12/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
••10
flees
OFFICE OF THE TOWN CLERK �c���F�Ur '
Town of Southold &VCQGt Application No33
Judith T. Terry, Town Clerk �` y:�
Town Hall, 53095 Main Road $10.00 - Residential
P. O. Box -1179 C." $25.00 - Non-Residential
Southold, New York 11971 O � �1`,
Telephone ?i ik s i
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
C'
Operation Permit No. ,
Fee $ /0.00-
DATE JO /p q}
OWNER NAME: ZJ4r3 S. ,J4 Mpnl V• 00u/Gti
OWNER MAILING ADDRESS: go. evf i i
6,4/0140,3, ivew Yr) I I ggel
OWNER PROPERTY ADDRESS: Gj 4t. G1/40,1 we
114cF k UM]
. 1631
OWNER TELEPHONE NUMBER: ,/f Ca) 0744
TAX MAP NO. : Section30 Block Z Lot 12-,CROSS STREET: -1/6 Stull/44w
TYPE OF SYSTEM: Septic Tankc/ New Existing ✓
Cesspool ✓ New Existing ✓
Residential V 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.)
AA.4
Signature of Ap icant
RECEIVED BY: 46/
Tow, Cler r s Office -
DAT E: RECEIVE
®CT 1 1 1995, -
fawn Clerk Southold
ib
,,.
t
14)n,„,43D/C)
laaP
L� z
X50"