HomeMy WebLinkAboutMcbride (2) OFFICE OF THE TOWN CLERK . c�FF(il,
Town of Southold
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road =s�
P. 0. Box 1179 C� ,°
Southold, New York 11971
Telephone =�(
(516) 765-1801
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 270 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool X
NAME OF OWNER: Robert and Laura McBride
OWNER MAILING ADDRESS: P.O. Box 743
Cutchogue, New York 11935
OWNER PROPERTY ADDRESS: 4295 Vanston Road
Cutchoque, New York 11935
OWNER TELEPHONE NUMBER: 516-734-5950
TAX MAP NO. : Section 111 Block 14 Lot 38
CROSS STREET: , Little Peconic Road
TYPE OF SYSTEM: Septic Tank New - Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: December-3, 1986
Judith T. Terry
• Southold Town Clerk
•
DATE: April 13, 1987
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(TOWN SEAL)
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OFFICE OF THE TOWN CLERK ,�j�FFO(/r -
Town of Southold �� _ sw, CDG Application No. € 1�/�/
Judith T. Terry, Town Clerk >�. t y
t < 7 Residential
Town Hall, 53095 Main Road � M ,
P. O. Box 1179 u' r �` Non-Residential
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Southold, New York 11971 O , �`
Telephone _ .(
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE L qs7
OWNER NAME: 20 T 4— P4-6?-U i 1 MAI-
OWNER MAILING ADDRESS: e- 0 , ( to X 1/Y'3
C Y TeKo 6- vc
OWNER PROPERTY ADDRESS: q v ? J V49--AtS 70.) 2 d
v -r C rl n 6- u c=
OWNER TELEPHONE NUMBER: '1, 3
TAX MAP NO. : Section I 1 \- Block ( f Lot 3
CROSS STREET: L L 7 C C o N (C 0 14`1b
TYPE OF SYSTEM: Septic Tank V New Existing ✓
Cesspool V New Existing
Residential ✓ Non-Residential
DATE OF PREVIOUS PUMP-OUT: l 'q 3/g
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.)
coe,
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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