HomeMy WebLinkAboutDooley (2) Ili WM&
JUDITH T.TERRY � `l? ' �
.� �.�. Town Hall,53095 Main Road
TOWN CLERK c� _t- L _ ; P.O.Box 1179
' Southold,New York 11971
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REGISTRAR OF VITAL STATISTICS ± V�1
MARRIAGE OFFICER � - �� Fax(516)765-1823
RECORDS MANAGEMENT OFFICER : 01 `D V„10' Telephone(516)765-1800
FREEDOM OF INFORMATION OFFICER o „„ ,i•s'
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3326-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner DOOLEY, PETER AND LUZVIMINDA
Mailing Address 1 4235 BAYVIEW ROAD
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 4235 BAYVIEW ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-3282
Tax Map No. section 78.00 block 2 lot 17.000
Cross Street BAYWATER AVENUE
Issue Date: 5/04/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK �FF0(/(°'-
Town of Southold � . (4 Application No. 33
Judith T. Terry, Town Clerk �� y
Town Hall, 53095 Main Road a $10.00 - Residential
P. O. Box 1179 cn ;' $25.00 - Non-Residential
Southold, New York 11971 - O �$
Telephone .Q( /it `tsee): �
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE 4127'g5
OWNER NAME: PETER d Loatni1iNDA, 300U)1
OWNER MAILING ADDRESS: 171235 iLD
SouTftaLa , NY 119-) )
OWNER PROPERTY ADDRESS: 4a�,� e. ,vkle)
OWNER TELEPHONE NUMBER: X(,5. 3a iz
TAX MAP NO. : Section �cP Block Lot
CROSS STREET:
TYPE OF SYSTEM: Septic Tank / New Existing V
Cesspool ,/ New Existing y
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.)
V 1�
Signature of Applig4-0,,./
RECEIVED BY: octiNED
T wn C[erk's Office
DATE: MAY 1 1995
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