HomeMy WebLinkAboutMcBride g re-1
Aft
Town Hall, 53095 Main Road
� �1 P.O. Box 1179
®� �� ' Southold, New York 11971
JUDITH T.TERRY �,,,ii %� FAX(516)765-1823
TOWN CLERK TELEPHONE(516)7654801
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. 1440-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner MCBRIDE, DONALD AND VERONICA
Mailing Address 1 4600 MAIN ROAD
Mailing Address 2
City St Zip LAUREL NY 11948-0000
Property Address 1 4600 MAIN ROAD
Property Address 2
City St Zip LAUREL NY 11948-0000
Owner Telephone No. 516-298-3986
Tax Map No. section 125.00 block 3 lot 12.000
Cross Street ALDRICH LANE
Date Of Last Pump Out 0/00/00
Issue Date: 4/19/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK .8
OFFICE / />
Town of Southold � ... t Application No. Z
s ,
Judith T. Terry, Town Clerk 0' Ate, •�
$10.00 - Residential \/`�
Town Hall, 53095 Main Road : ;;;-`4-4,44 -
P. O. Box 1179 u' ' r tri $25.00 - Non-Residential
Southold, New York 11971 r, - Y . .."•••0 •
Telephone _Oj . i
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /O, 2
DATE "51-/P- 90
OWNER NAME: 0 MJ11 f_D \ 1,6 L C ts-1l Cfi) �: i D r (4):u-of
OWNER MAILING ADDRESS: L600 i} \ Iti R ,
u fa F L A) I l 9 Lig
OWNER PROPERTY ADDRESS: S )C) ME
OWNER TELEPHONE NUMBER: 576 -2 9R — 39 Pg
TAX MAP NO. : Section /r1 S .J J Block 0 ,00 Lot C:J/20
CROSS STREET: , f p1/ ( F tiit'F
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool � New Existing )7.-
Residential
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: 3 — 6) 4
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.)
A610,4,at /5/(/
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
-?f-e--.) H 11a/G4/1.
•
•
r
I \
•
•
•
•
f 1c�VC•1 t�L-n YF' O Z4J t c..i4
OC>
0
k JiaEL Ail�111/9 1 G 'v
6 '
rte.
`i .