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Home My WebLink AboutKelleher 1 it G � JUDITH T.TERRY �I Town Hall, 53095 Main Road TOWN CLERK y P.O. Box 1179 Southold, New York 11971 REGISTRAR OF VITAL STATISTICS , MARRIAGE OFFICER ` � ®�•11 Fax(516) 765-1823 RECORDS MANAGEMENT OFFICER : ®.� .;;: #10d Telephone (516) 765-1800 FREEDOM OF INFORMATION OFFICER —��„ ,.••� OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 3480-R Residential X Non-Residential Fee $ 10.00 New Existing X Name Of Owner KELLEHER, DANIEL C Mailing Address 1 965 PIKE STREET Mailing Address 2 City St Zip MATTITUCK NY 11952-0000 Property Address 1 965 PIKE STREET Property Address 2 City St Zip MATTITUCK NY 11952-0000 Owner Telephone No. 516-298-9467 Tax Map No. section 140.00 block 2 lot 25.000 Cross Street WICKHAM AVENUE Issue Date: 6/25/96 Judith T. Terry Southold Town Clerk (TOWN SEAL) -zt IIS OFFICE OF THE TOWN CLERK s,�FF� G� sl Town of Southold �� ‘QG,\ Application No. f' w Judith T. Terry, Town Clerk �� r1Y ,. r; �, .� $10.00 - Residential Town Hall, 53095 Main Road i ,. . P. O. Box 1179 u' 't.--4.. �' %` $25.00 - Non-Residential Southold, New York 11971 O ®xl�t.- ,Gs. Sr �0 Telephone ®.( 1" 01, (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ /0,, a DATE „20 !4 9 &/ OWNER NAME: L/)NjF7 c (1'Eez NFrK OWNER MAILING ADDRESS: qcs- /044- T- . iiFf7-T /T(i ci lu,it , OWNER PROPERTY ADDRESS: - - /4NI OWNER TELEPHONE NUMBER: 09,9F- -- - Y6 '7 TAX MAP NO. : Section /y©-02-ArBlock Lot CROSS STREET: VP( CV7`/tM A t/6-- TYPE /�TYPE OF SYSTEM: Septic Tank _ - - _New Existing j Cesspool v New Existing 7:------- Residential Non-Residential LOCATION MAP: Must he attached hereto before permit may be issued. (Locate building and system; give north arrow and feet of distance, approximately, to building and closest road.) yr ..,.._-_,.......,... • 74..dj�f Signature of Applicant RECEIVED BY: Town Clerk's Office DATE: