HomeMy WebLinkAboutKeogh (2) 4,01
Town Hall, 53095 Main Road
P.O. Box 1179
e®./ i-Lss �i,�` Southold, New York 11971
JUDITH T.TERRY %�..z�zr.%'� 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. 1309-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner KEOGH, JOHN A.
Mailing Address 1 P. O. BOX 646
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 875 PIKE STREET
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-4263
Tax Map No. section 140.00 block 2 lot 24.000
Cross Street WICKHAM AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 11/15/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
OFFICE OF THE TOWN CLERK �FFO 1
Town of Southold �� Co = Application No. /� /
Off, .. ° .:�-� G
Judith T. Terry, Town Clerk : : ' xy
Town Hall, 53095 Main Road $10.00 - Residential
O. Box 1179
P. u' z $25.00 - Non-Residential
Southold, New York 11971 O `® atm..
Telephone ��
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE August 114., 1989
OWNER NAME: John A. Keogh
OWNER MAILING ADDRESS: PO Box 614.6
Mattituck, New York 11952
OWNER PROPERTY ADDRESS: 8.7-5 _Pike Street - _
Mattituck, New York 11952
OWNER TELEPHONE NUMBER: 298-1.263
TAX MAP NO. : Section 140 Block 2 Lot 211.
CROSS STREET: Wickham Avenue
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: 7/27/89
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.)
4114 '
Signature of A.. .lic t
RECEIVED BY:
RECEMOn Clerk's Office
DATE: NOVI r 19bi
Iowa Cleelz So.r�i®I�
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