HomeMy WebLinkAboutEgan Town Hall, 53095 Main Road
P.O. Box 1179
Southold,New York 11971
JUDITH T.TERRY FAX(516)765-1823
TOWN CLERK TELEPHONE(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. 1198-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner EGAN, NELLIE
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Mailing Address 1 575 MILL CREEK DRIVE
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Mailing Address 2
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City St Zip SOUTHOLD NY 11971-0000
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Property Address 1 575 MILL CREEK DRIVE
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Property Address 2
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City St Zip SOUTHOLD NY 11971-0000
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Owner Telephone No. 516-765-1667
Tax Map No. section 135.00 block 3 lot 33.000
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Cross Street GROVE DRIVE
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Date Of Last Pump Out 0/00/00
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Issue Date: 7/31/89 Judith T. Terry
-------- Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK
Town of Southold O�� COl/ Application No.
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road $10.00 - Residential
P. 0. Box 1179 cry $25.00 - Non-Residential
Southold, New York 11971 O
Telephone
(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: �,i=L-L-L E EC;Av"-,
OWNER MAILING ADDRESS: 5-7 ,LIL- CZeA=,e- :QV-1-wXjJ;=
OWNER PROPERTY ADDRESS:--
OWNER
DDRESS:OWNER TELEPHONE NUMBER: 76,57777
TAX MAP NO. : Section Block 0 Lot
CROSS STREET: i9m �{ =� '?
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing Y
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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.)
Signature of A' plicant
RECEIVED BY:
Town Clerk's Office
DATE:
JUL 31
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