HomeMy WebLinkAboutO'Sullivan, Michael (2) SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4323-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner O'SULLIVAN, MICHAEL & ELIZABET
Mailing Address 1 363 DIVISION STREET
Mailing Address 2
City St Zip SAG HARBOR NY 11963-0000
Property Address 1 170 MAPLE STREET
Property Address 2
City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 631-725-0361
Tax Map No. section 42.00 block 1 lot 12.000
Cross Street 6TH AVENUE
Issue Date: 9/25/06 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE ; Town Hall,53095 Main Road
TOWN CLERK a Z P.O.Box 1179
REGISTRAR OF VITAL STATISTICS ��O t Southold,New York 11971
MARRIAGE OFFICER t. ,i' Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER -�l * `4S„i � Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER ,,,,,,.i" southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
OPERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @$10 or Non-Residential @$25 Application No. y1' "1
Permit No. 339 R
Owner Name TVlc16\ ,\\iVvti
Owner Mailing Address SU)
S t% tAw,bos, 1•11 kkgt 42
Owner Property Address \lb NAae\e. St
Owner Telephone No. (44 7a5- U 3+4 1
Tax Map No: Section V. 4 2 Block Lot I -2-
Cross
Cross Street Vv`.
Please check each that applies: New Construction
Alteration to Existipg System
Residential V Non-Residential
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. (Locate
building and system; give north arrow and approximate distance in feet from system to building
and closest road. New construction may submit copy of survey with SCHD approval.)
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Signature of Applicant Date
Received by:
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