HomeMy WebLinkAboutKennedy (2) JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS :TA �: Southold, New York 11971
MARRIAGE OFFICER �V!" Fax (516) 765-1823
1 Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1763-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner KENNEDY, WILLIAM
Mailing Address 1 BOX 93
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 FLEETWOOD ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-6331
Tax Map No. section 137.00 block 4 lot 35.000
Cross Street BETTS STREET
Date Of Last Pump Out 0/00/00
Issue Date: 9/20/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
OFFICE OF THE TOWN CLERK �FFU 7‘
Town of Southold 0�� +; CQ Application No.
Judith T. Terry, Town Clerk . z t< ta , �,
Town Hall, 53095 Main Road '
$10.00Residential (/
P. O. Box 1179 U' $25.00 - Non-Residential
Southold, New York 11971 ® �•'
Telephone .(
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. )74,at
Fee $ /b
F ,
DATE
OWNER NAME: LA, 1 (l _ ge.77,-A
OWNER MAILING ADDRESS: O 1C--
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OWNER PROPERTY ADDRESS: F`,.-QpisNAM-el_
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OWNER TELEPHONE NUMBER:
TAX MAP NO. : Section I � -) Block et7 Lot G -5 if"'
CROSS STREET: `P
TYPE OF SYSTEM: Septic Tank New Existing
_ _ "" Cesspool New Existing
Residential Non-iResidential
DATE OF PREVIOUS PUMP-OUT: K
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 Applicant!
RECEIVED BY:
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� Oown er s Office
DATE: rre� �, , 191 -
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