HomeMy WebLinkAboutHickey OFFICE OF THE TOWN CLERK • f Q�CO
Town of Southold ��
Judith T. Terry, Town ClerkAV 'r
Town Hall, 53095 Main Road k• ..,'�'' 'mac
Tvc !1
P. O. Box 1179 urs
Southold, New York 11971 Qs ® �- ••
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD, WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 341 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool X
NAME OF OWNER: James F. J. Hickey,
OWNER MAILING ADDRESS: P.O. Box 343
Southold, -New York 11971
OWNER PROPERTY ADDRESS:575 Orchard Road
Southold, New York 111917
OWNER TELEPHONE NUMBER: 516-765-2265
TAX MAP NO.; Section 66 Block 2 Lot 9
• CROSS STREET: Rogers Road
TYPE OF SYSTEM: Septic Tank New Existing -
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: October 1980
Judith T. Terry -
Southold Town Clerk
DATE: , July 15, 1987 -
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK 1C.OFair ? �ff
Town of Southold �o �Q Application No. tJ `77
Judith T. Terry, Town Clerk
Town Hall 53095 Main Road Residential
P. O. Box 1179 u' ,,,Art ri ' . Non-Residential
Southold, New York 11971 O yzt, *A �•`
Telephone •
= 1
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $�(
DATE 7/15/87
OWNER NAME: James F. J. Hickey
OWNER MAILING ADDRESS: P . O. Box 343
Southold , NY 11971
OWNER PROPERTY ADDRESS: 575 Orchard Road, Southold , NY 11971
OWNER TELEPHONE NUMBER: 516-765-2265
TAX MAP NO. : Section 66 Block 2 Lot 9
CROSS STREET: Rogers Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: OO&€ I9 o
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.)
Sig ture of Ap icant
RECEIVED BY:
Town Clerk's Office
DATE:
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