HomeMy WebLinkAboutHeaney 411 cOf k,
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- ` ` �' �' Town Hall, 53095 Main Road
kcV P.O. Box 1179
Southold, New York 11971
JUDITH T.TERRY --r_�-drAvAaito° TELEPHONE
rOWN 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. 894-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner HEANEY, JOHN R.
Mailing Address 1 511 BAILEY AVENUE
Mailing Address 2
City St Zip GREENPORT NY 11944-0000
Property Address 1 511 BAILEY AVENUE
Property Address 2
City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 516-477-1533
Tax Map No. section 34.00 block 3 lot 16.000
Cross Street CHAMPLIN PLACE
Date Of Last Pump Out 0/00/00
Issue Date: 11/01/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
%DJ . _, '47 ....
OFFICE OF THE TOWN CLERK S\\ FOIL-
Town of Southold �, ea -- Application No. �g
Judith T. Terry, Town Clerk �� y0 d;xrtc.,i7 .. t3.:`, e /
Town Hall, 53095 Main Road az az 1-. £F -cResidential
p. 0. Box 1179 u-3 ° .0r.. ``- h�i
,.,, . . Non-Residential
Southold, New York 11971 O�i .-k-'04'i•� 0 �$
Telephone ,fix `� !�
•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
•
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
OperationPermit No. 99/71.
f O
Fee $ .
. DATE , 7, 07 r
, � �OWNER NAME: �. �
OWNER MAILING / DDRESS: 3-1 / ee / , 0 ' •
1 . , ,. 9 9j . v / K144
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: ` 5 / L - 47 7 -1 s ' {
TAX MAP NO. : Section __?1-/- Block _ Lot /,‘ _
CROSS STREET: fl) / r//N /01 Ace_
TYPE OF SYSTEM: Septic Tank New Existing 1.------
Cesspool
Cesspool ,. New Existing
ResidentialV-- Non-Residential
DATE OF PREVIOUS PUMP-OUT: / I7
LOCATION MAP: Must be attached he eto 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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Signatc
of Applicant
RECEIVED BY: L� / / ` /
7`o n Cl- k's O, fice
DATE: /A a�j/e7
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