HomeMy WebLinkAboutLangan JUDITH T. TERRY i Town Hall, 53095 Main Road
TOWN CLERK n Gi P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER ��� Fax (516) 765-1823
N.®� 0 �® ! Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3064-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner LANGAN, DONALD AND MARY JANE
Mailing Address 1 P. O. BOX 122
Mailing Address 2
City St Zip CUTCH,OGUE NY 11935-0000
Property Address 1 255 BEEBE DRIVE
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-6034
Tax Map No. section 97.00 block 7 lot 24.000
Cross Street EUGENES ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 7/21/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK 'c.SFDLir�
Town of Southold Application No. 36)6
,4
Judith 1". 'Terry, Town Clerkr t.:41 $10.00
Town"Hall, 53095 Main Road ' _ - Residential
P. O. Box 1179 tri �, ; $25.00 - Non-Residential
Southold, New York 1197114`
5 'i *
•Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ I®. 00
DATE 6l36/ 9-3
OWNER NAME: / of)41 icy --o-74 E L i &'G , n)
OWNER MAILING ADDRESS: P. O. dy, 9 a a.
0 J ) .'
OWNER PROPERTY ADDRESS: GI z'`J xyi- v�
_ C1,1*c ,-) 0 ve. y 1 19 3 .5
OWNER TELEPHONE NUMBER: 1,31-/-6- tf
TAX MAP NO. : Section 9 7 Block 7 Lot
CROSS STREET: F_ ivies
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool 1/ New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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.)
C
Signat of Applic
RECEIVED BY: �' ' -C
own Clerk's Office
DATE: if 51/ �-�
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