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HomeMy WebLinkAboutKavanagh 00 JIneei , ( - ° fi Town Hall, 53095 Main Road P:O. Box 1179 Southold, New York 11971 JUDITH T.TERRY = °4 1-i2? 'do° TELEPHONE TOWN CLERK (516) 765-1801 REGISTRAR OE VITAL STATISTICS OFFICE OF THE TOWN CLERIC TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 845-R Residential X Non-Residential Fee $ 10. 00 Septic Cesspool X New Existing X Name Of Owner KAVANAGH, JOHN C. Mailing Address 1 500 GLENN ROAD Mailing Address 2 City St Zip SOUTHOLD NY 11971-0000 Property Address 1 500 GLENN ROAD Property Address 2 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 516-765-3301 Tax Map No. section 78. 00 block 2 lot 23 .000 Cross Street MAIN BAYVIEW ROAD Date Of Last Pump Out 0/00/00 Issue Date: 9/19/88 Judith T. Terry Southold Town Clerk (TOWN SEAL) • „„ . OFFME”GF•THE TOWN CLERK 'C��FFO(�' '= Town of Southold Q dip, lD Application No. Judith T. Terry, Town Clerk :1 h�' -:� Town Hall, 53095 Main Road '`'` �G I Residential � � • u • o P. O. Box 1179 cn °; yi tie � Non-Residential Southold, New York 11971 Telephone 19°14-- `� (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT' APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ • DATE 9- ) 7-- S • OWNER NAME: ,�©�fn1 e, Y/ /9 AI d 6-1-1 OWNER MAILING ADDRESS: 'SO -6 .40 / fib hi 014 Alp L,t 5 7J' OWNER PROPERTY ADDRESS: .5.10 0 ,eA/A) 4 o f� ,e7 f-� rD 1-1> Ili (�ye 11I 7 '7 OWNER TELEPHONE NUMBER: Ci �) LS .3 ©) TAX MAP NO. : Section 7 3 Block A. Lot 3 2 CROSS STREET: Ci , tJ BR )/ Vl 1� TYPE OF SYSTEM: Septic Tank X., New Existing 1C Cesspool New Existing Residential ><N Non-Residential DATE OF PREVIOUS PUMP-OUT: .5'7. 7g-r. LOCATION MAP: Must be attached hereto before permit may be issued. (Locate building and system; give north arrow and f feet of distance, approximately, to building and closest road.) �; i �_.r� Signature of ' pplicant RECEIVED BY: Town Clerk's Office DATE: . - .„,. • . v --_________________. . . ,Q• / , ili / 0 , _ ...„ , W1 4149 k - 4'\*\41'.'4 / "'1 if :., °‘)L o ll fililiV„,,,_,,It W.') .x, / IP r ./Ne/ 4\ ii '`'.z Z q .T.� vs1"L / C a �� �8 //° . 8,' , ‘.....?..,„ .--5r _, .... ? ' ...r A •.. 14. Q.,,.. ,,,.4 �p -o '( / • ) (1) . .2ty 0 fl., 0 .. 43. _, =›(:) I oi ., , / \6/ ,„() a ,- 0 e s. 0 ,VK �, z3 S ''sT� °` p00vOki , w N� sN.z �4NI 1 i C•,SS 2 wIP 47 \C) 1 -/ P° ). . Y / - • I/VEST ceLreesz7rEs TEST f-i0e.� '�`z, , Q S/TUA T.- _ o . �- 3011THOL£7 -C\ co c'0 ��al rr^^ -r'OrYN OF SOU r/-/OL,C� z � _ s o0 - vl N ,,e, UFi�OL,C COUNTY, / Y M.nIa. 1 c0, /9 7.3 i A,S' .SNoK/N Oh/ ibIA.d of WEST C'E..E:.e.67,577•97 .5 !�`, ' . .c"/G4."O e4UG. i 3, /.9 3 -, ,c'i'- i,ro. 38.48 ( Q r-7117e; o/ ro • Socv-7z-nc ,& `.Sc vir,9s .5C:71'7.e. . _ 4:c.L:,..,g /2 , L.5. C✓. Y. STAT .......................... - - UC. rvo. 32403 S.ETr�,1.-ET, N.Y. SCF�I =4O . _L____________ . ‘ . i _... . _._ . .- - _. - - -- - .- - _.... - - . _ . . _ _ _ _ _ _ . _ _ ... _ . ______ __- - -