HomeMy WebLinkAboutKenney JUDITH T.TERRY ® 4 ; Town Hall, 53095 Main Road
TOWN CLERK k g P.O.Box 1179
REGISTRAR OF VITAL STATISTICS ‘1) �, Southold,New York 11971
MARRIAGE OFFICER 44 C�� ��� Fax(516)765-1823
RECORDS MANAGEMENT OFFICER = °I � ���1 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. 3425-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner KENNEY, MRS. RAYMOND
Mailing Address 1 3655 STILLWATER AVENUE
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 3655 STILLWATER AVENUE
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-5185
Tax Map No. section 136.00 block 2 lot 11 .000
Cross Street MAIN ROAD
Issue Date: 1/04/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK ,cvFFU(,I(I,'
Town of Southold �N C0",v Application No.� .�
Judith T. Terry, Town Clerk ��� �' $10.00 - Residential �!
Town Hall, 53095 Main Road
P. O. Box 1179 U' r• ' : $25.00 - Non-Residential
Southold, New York 11971 Oyto i�1'
Telephone y► f.-
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /O
DATE
c �
OWNER NAME: AR..r, ow v JI 4-lnlE,.
y
OWNER MAILING ADDRESS: �3�,5.5 ,f� -1?
CwfcAa6c. �) /'v64 /
i gond/ ///C�
3.1-
- OWNER PROPERTY ADDRESS: ,3(,,51.5-- �.I -,tL I,I rd ,Qi,r&
, a 24, X19'3J
OWNER TELEPHONE NUMBER: 7A-. .S/
TAX MAP NO. : Section-47-34ff Block Lot 21
'CROSS STREET:
TYPE OF SYSTEM: Septi-c Tank ;f' New Existing
Cesspool New Existing
Residential X Non-Residential
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 lof Applicant
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RECEIVED BY:� /- '
Town''Clerk'.s Office - -
,
DATE-: /L..77c-C. ' . . - -
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