HomeMy WebLinkAboutKiernan (2) 41filik4'e‘
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� g Town Hall, 53095 Main Road
!' ��i PLO. Box 1179
1 ® s z Southold, New York 11971
JUDITH T.TERRY Vol ��. TELEPHONE
TOWN CLERK `•*-vtiowi (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. 3601-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner KIERNAN, FRANCIS
Mailing Address 1 1600 GIN LANE
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 1600 GIN LANE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-1599
Tax Map No. section 88.00 block 3 lot 18.000
Cross Street
Issue Date: 4/07/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK c3�FFO! Lp
Town of Southold �® C®G Application No3 O/
Judith T. Terry, Town Clerk
Town Hall, 53095 Main RoadI $10.00 - Resid ntial
r�
P. O. Box 1179 v' :� ° ► �' $25.00 - Non-Residential
Southold, New York 11971 %•`p-
Telephone
Telephone ( xlat •
°
(516) 765-1801 , •7
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
•
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /0>60
DATE 4//97
OWNER NAME: /-/MiC-i /-/T/
OWNER MAILING ADDRESS: l/0�D 6ifi1 ilk
sd1Wii-D.Z.1))Aril. il97/
OWNER PROPERTY ADDRESS : ,/460 6j/{/ ir -
SSau77/6 , N 1 /1Y7/
OWNER TELEPHONE NUMBER: i76-746.--/579
TAX MAP NO. : Section Block Lot
CROSS STREET:
TYPE OF SYSTEM: Septic' Tank , , • New Existing
Cesspool New Existing
Residential___ 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 of Appiican't
RECEIVED BY:
Town Clerk's Office
DATE:
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