HomeMy WebLinkAboutMcburney 1�ii
Town Hall, 53095 Main Road
t'®""� ,t�� P.O. Box 1179
`` .�� Southold, New York 11971
JUDITH T.TERRY >,,,,�r�� EFAXPH (516)765-18
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. 1221-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner MCBURNEY, LORETTA
Mailing Address 1 385 GULL POND LAND
Mailing Address 2
City St Zip GREENPORT NY 11944-0000
Property Address 1 385 GULL POND LANE
Property Address 2
City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 516-477-0308
Tax Map No. section 35.00 block 4 lot 6.000
Cross Street NORTH ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 8/25/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK C3 �'3\\FES► "
Town of Southold � C� - Application No.
Judith T. Terry, Town Clerk 44,
Town Hall, 53095 Main Road ,. � -4 7 $10.00 - Residential
P. O. Box 1179 cn ` '
- $25.00 - Non-Residential
Southold, New York 11971 4 4140,
Telephone _/01 ��
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE
OWNER NAME: �� /2 � •
u ,
OWNER MAILING ADDRESS: g
&.9
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: alb �7 � 36 a—
TAX MAP NO. : Section Block V Lot
CROSS STREET: Ao/
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential 1 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.)
0
Signature of ApplicantC/
RECEIVED BY: , j(JC.��
w Clerk's Office
DATE: r Co