HomeMy WebLinkAboutMcburnie (2) .4*ft
�i Town Hall, 53095 Main Road
�h P.O. Box 1179
Southold, New York 11971
JUDITH T.TERRY TELEPHONE
TOWN CLERK (516) 765-1801
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. 3586-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner MCBURNIE, JAMES AND MARILYN
Mailing Address 1 933 NEW SUFFOLK ROAD
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 933 NEW SUFFOLK ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-6024
Tax Map No. section 102.00 block 6 lot 24.000
Cross Street MAIN ROAD
Issue Date: 2/11/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
+ ., ,oma
OFFICE OF THE TOWN CLERK ��OFD
Town of Southold 1 .% ��QG \ Application No. �'C'
Juditth T. Terry, Town Clerk . �`
Town, Hall, 53095 Main Road a $10.00 - Residential
P. O. Box 1179 tri ‘' $25.00 - Non-Residential
Southold, New York 11971 'Yv . '1
Telephone 64_0.( _ I� '/
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. / T? 9
Fee $ /O. ,
DATE c'"2/ A)/7
OWNER NAME: J jy7) ' aLi y,r} /77efv,-/-7/e----
OWNER MAILING ADDRESS: 9 3 3 )1 ew 5- ct 244/k. ,-0(...... s-3
G6e._-,LL.,, Qi-a d.,. 1 Aly // 4 '. 1
----- owNEo PROPERTY ADDRESS : S n, il' 7 yam a-&' Q -Z-c) (9-e...--
OWNER
(J`e...--
OWNER TELEPHONE NUMBER: 73 17 -- 40= L/
TAX MAP NO. : Section Block Lot oZ 171
CROSS STREET: ff)e.a� ..S..CL4- U/A /2,4 rn a/A-7 RS.
TYPE OF SYSTEM: Septic. Tank ) New Existing
Cesspool New Existing
Residential 'Y Non-Residential
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.)
Sig -ture of Applicant
RECEIVED BY: l/u
},
Town Clerk's Office
DATE: d
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