HomeMy WebLinkAboutMcdermott 11 V /1
ceJUDITH T. TERRY .G Town Hall, 53095 Main Road
TOWN CLERK : ® ep, P.O. Box 1179
,� Southold, New York 11971
REGISTRAR OF VITAL STATISTICS ��' Fax (516) 765-1823
MARRIAGE OFFICER O �' Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICERO,l 4
FREEDOM OF INFORMATION OFFICER ��i ���
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3201-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner MCDERMOTT, EDWARD & DOROTHY
Mailing Address 1 1530 THERESA DRIVE
Mailing Address_ 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 1530 THERESA DRIVE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-2238
Tax Map No. section 115.00 block 14 lot 2.000
Cross Street RICHARD STREET
Issue Date: 5/19/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK •COFO(/r
C Application No.
Town of Southold �� 3.. QG 3 32,0
Judith T. Terry, Town Clerk � , �
Town Hall, 53095 Main Road
-< $10.00 - Residential
P. O. Box 1179 cr3V; ,; . z $25.00 — Non-Residential
Southold, New York 11971
Telephone 410/01.7 *V-,0 rP •
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(516) 765-1801 '`• "'l'
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE /A9/ �J /9/
OWNER NAME: e-- 11 u ,
OWNER MAILING ADDRESS: /5-30 Ierejc 9,-
OWNER
nOltirble-k— )At/
PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: 29 ? l2 r
TAX MAP NO. : Section ar Block /1/ Lot Z
CROSS STREET: ct_ret Se. i
TYPE OF SYSTEM: Septic Tank j New' Existing j/-
Cesspool
Cesspool New Existing
Residential 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.)
A--"dlin7,1,0e 40 ' -
pp
Signature of Applicant
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RECEIVED BY: _
Town Clerk's Office
DATE:
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