HomeMy WebLinkAboutKennelly 1 ,
r' Town Hall, 53095 Main Road
P.O. Box 1179
� � Southold, New York 11971
JUDITH T.TERRY == r�� FAX(516)765-1823
TOWN CLERK TELEPHONE(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. 948-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner KENNELLY, JOHN J.
Mailing Address 1 2000 DEEP HOLE DRIVE
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 2000 DEEP HOLE DIRVE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-9500
Tax Map No. section 123.00 block 4 lot 2.000
Cross Street NEW SUFFOLK AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 12/08/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK �FFOIA' --
Town
Town of Southold � 4QG� , Application No. i6ciK
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Judith T. Terry, Town Clerk � s � Residential
Town Hall, 53095 Main Road t4-;‘ � s-
p. O. Box 1179 =,
ri Non-Residential
Southold, New York 11971 " - > •�`
0".Telephone •
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT -
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE / 2 f, F
OWNER NAME: jr /V-iti iA-1&6,L y
OWNER MAILING ADDRESS: ( 7o--r-(1 � Dce
AA---r N_ y
OWNER PROPERTY ADDRESS: 54-4/
OWNER TELEPHONE NUMBER: 07-1.7 ,-S-74'
TAX MAP NO. : Section ip 3 Block `f Lot
CROSS STREET: /4:4,,
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ✓/ New � Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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.)
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Signa - if Applicant
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RECEIVED BY: 1 (1(}/--14------d
Tow Clerk's Office
DATE: / Fr
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