HomeMy WebLinkAboutMcdavid (ill CA airett
W
AW; Town Hall, 53095 Main Road
�y® Q tiro' P.O. Box 1179
'‘!010,/ ,s�, �01 Southold, New York 11971
JUDITH T.TERRY '. FAX(516)765-1823
TELEPHONE(516)765-1801
TOWN CLERK
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. 950-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner MCDAVID, MARY
Mailing Address 1 P. O. BOX 882
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 750 PINE AVENUE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-3362
Tax Map No. section 77.00 block 3 lot 5.000
Cross Street BIRCH
Date Of Last Pump Out 0/00/68
Issue Date: 12/09/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
.. „
OFFICE OF THE TOWN CLERK cilf FOC,-
.
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Town of Southold &,% CQG' Application No.9,0
Judith T. Terry, Town Clerk y
Town Hall, 53095 Main- Road _ Residential
P. O. Box 1179 � 1;;;-'-; ° - &i ; Non-Residential
Southold, New York 11971 O i''
Telephone 0,( * /tW
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 9-5-
Fee
51Fee $ %a r
DATE bac q 1988
1n n
OWNER NAME: M i 1' Q l�►n 11 r ► = llAll it)
OWNER MAILING ADDRESS: P b, Gox Q$ L
5 o'i oc. p , IV.� ( ( (7 I •
OWNER PROPERTY ADDRESS: 7r0 Y( 1.i Pt Ave
u-x-f,406..,0 1,)(1, 1471
OWNER TELEPHONE NUMBER: ( 51( "1105 `. 33L�
TAX MAP NO. : Section 77 Block 3 Lot lc
CROSS STREET: 1?, tipgL1
TYPE OF__SYSTEM: Septic Tank New Existing ✓
Cesspool + New Existing ✓
Residential w' Non-Residential
DATE OF PREVIOUS PUMP-OUT: 13. ,
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.)
1 r/1 C r
x
Sig fpture of Applicant
RECEIVED BY:
Town Clerk's Office .,
DATE: i,-7(17i
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. McDAVID
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