HomeMy WebLinkAboutKillian /0,�oStFFO`,rc
JUDITH T.TERRY ��� Ot : Town Hall, 53095 Main Road
TOWN CLERK y 2 1 P.O. Box 1179
1 Southold,New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER : yOFa] (516) 765-1823
RECORDS MANAGEMENT OFFICER --- ®.1 Jig �►`a ���� 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. 3511.5-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner KILLIAN, WILLIAM AND MARGARET
Mailing Address 1 P. O. BOX 446
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 5102 MILL ROAD
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-9125
Tax Map No. section 106.00 block 6 lot 5.000
Cross Street NAUGLES ROAD
Issue Date: 11/15/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK � IFU(,r
4%c) 01 --
Town of Southold
G -35 5�
Judith T. Terry, Town Clerk �� r" � Application No.
Town Hall, 53095 Main Road $10.00 - Residential .�
P. O. Box 1179 v' x1 �{ �" Z' $25.00 - Non-Residential
Southold, New York 11971
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Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATEAJ; 76
OWNER NAME: 1L1 AL, 011--)1P9'&20-(17 116. 11-) in/ ./
OWNER MAILING ADDRESS: i Poi°3 (-) 9.. c
,/vy
OWNER PROPERTY ADDRESS: L—/6a.. t - I
$$9,0 717;.7-0C11<, GIVY
OWNER TELEPHONE NUMBER: 576 g vi " /r
TAX MAP NO. : Section /0' 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 f'p licant
RECEIVED BY:
Town Clerk's Office
DATE:
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+ C` `~�'_ I # SECURITY TITLE a GUARANTY CO. ;t"
,� TITLE NO. S 376314 A
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44 WI L L I,A M. R. K I`L L I AN Prepared in!_aocordOnc� ''
�1. ' iRVEYORS a ENGINEER_ S ' P: C. k as eatabliado by
, � ? MARGARET-, M. 1 L L I AN �tandcrds fob""fid+ '°'^rem'
( 516 ) 765 - 5 02 0 L 1.A.L S. acrd approved and adopts a -.-•T=
P. 0 . BOX 909 The Naw York St® d®�
for such "uae,by,
M Al N ROAD _ • rale Association: ' ;; .•
SOUTHO L O , N .Y . 11971 ` r
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