HomeMy WebLinkAboutMcbride OFFICE OF THE TOWN L :RIS ' •ci\f FOUr
Town of Southold N) , COG
Judith T. Terry, Town Clerk
- Town Hall, 53095 Main Road 8 = ' . -
P. O. Box 1179
Southold, New York 11971 _O ��•,,,
Telephone � *
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 49 Residential XX
Non-Residential
Fee $ 10.00
Septic Cesspool XX
NAME OF OWNER: Jane A. McBride
OWNER MAILING ADDRESS: 17 Cohasset Lane
Cherry Hill, New Jersey 08003
OWNER PROPERTY ADDRESS: 145 Mary's Road
Mattituck, New York 11952
OWNER TELEPHONE NUMBER: 609-751-1965
TAX MAP NO. : Section 140 Block 2 Lot 36
CROSS STREET: Pike Street
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool XX New Existing XX
Residential xX Non-Residential
DATE OF PREVIOUS PUMP-OUT: 1985
Judith T. Ter
Southold Town Clerk
DATE: September 18, 1986
`; (TOW SEAL) ;
„
OFFICE OF THE TOWN CLERK �c �F� J1G
Town of Southold o���� CQG'., Application No. /
Judith T. Terry, Town Clerk . �4 i> 4
Town Hall, 53095 Main Road a yz„' ”'R .c Residential
P. O. Box 1179 tri `'' ��' Non-Residential
Southold, New York 11971 Off, ' ' �`
Telephone IA
_ 1
(516) 765-1801
RECEIVED TOWN OF SOUTHOLD
SEP 181986 SOUTHOLD WASTEWATER DISPOSAL DISTRICT
mum Clerk Southold
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. �F
Fee $ /0,0)
DATE 9/3/6-C7
_ e
OWNER NAME: J PrsJ A- M C Bk.
OWNER MAILING ADDRESS: 1-1 0 hA-ss e-- LAne__
OWNER PROPERTY ADDRESS: 4 C`r\ S C4 .
01131-4t,-\-ta c kL LJLi(
OWNER TELEPHONE NUMBER: Q0...:0 i �.� �—( of
TAX MAP NO. : Section 1 bb O Block I `I 0 Lot 2- 3
CROSS STREET: t S-k
TYPE OF SYSTEM: Septic Tank New Existing
/
Cesspool V New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: 1 FC'
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/2-7L-e_67.
✓7t e_
Signature of pplicant
RECEIVED BY: ( ii}cr-C,,__
Townrk's Office
DATE: , , , „//'
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