HomeMy WebLinkAboutKeogh �
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• Town Hall, 53095 Main Road
P.O. Box 1179
®��� Southold, New York 11971
JUDITH T.TERRY „/ i�•1° 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. 1011-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner KEOGH, CORNELIA C.
Mailing Address 1 HALLOCK, BEVERLY J.
Mailing Address 2 RR 1, BOX 67855 NORTH ROAD
City St Zip GREENPORT NY 11944-0000
Property Address 1 NORTH ROAD
Property Address 2
City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 516-477-0094
Tax Map No. section 33.00 block 3 lot 18.000
Cross Street MCCANN LANE
Date Of Last Pump Out 9/00/85
Issue Date: 2/08/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
1)S. i�
OFFICE O0.,' TIlE TOWN CLERK SCO r - '_
Town of Southold �% y�CQG' , Application No. / 611
Judith T. Terry, Town Clerk .` - £` z.:,,,-. ,
a :, .-- Residential
Town Hall, 53095 Main Road ;'�
" ='` -. Non-Residential
P. O. Box 117 9 cry � � `'
Southold, New York 11971 0 = :' II
Telephone • la/ `j6 0 t.�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ 10: 00
DATE 02, - a 8 - 8f
OWNER NAME: CoQgELIA C. ttEoGN PO B VEQLy J. 1-CI;LLock_
OWNER MAILING ADDRESS: R12.,- - 11 box (o7B.5 Q02-1- 1 A�
G2�c11PoP9-i N Y 119 -4- r '
OWNER PROPERTY ADDRESS: 7f 4 1) P7)nK# /„r1 p,5-5 kloRTIA &z1:›
L� L (0525 Rolorrr PQ
G-EE,Ek n -r- I til Yl 191I-4
OWNER TELEPHONE NUMBER: 4711 - 009 4.
TAX MAP NO. : Section 033 Block O3 Lot 0181
CROSS STREET`1,1)M i1 y i LAME (7/45) Moorze* LAtAE. NdR-rN
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential \ . Non-Residential
DATE OF PREVIOUS PUMP-OUT: pq 185-
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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RECEIVED BY: 3C (AAX4-ter
T n Clerk's Office
DATE: 9-/th9
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TAX _ HAP - 1\10. 1000/0-3310 /-0118-_ -FIOtJ� NQ _==6'7:8 55 (F1ALY16"52_55)__
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