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JUDITH T. TERRY ; Z d : Town Hall, 53095 Main Road
TOWN CLERK O r-rt P.O. Box 1179
REGISTRAR OF VITAL STATISTICS � Southold, New York 11971
MARRIAGE OFFICERyQ r. .$
•�� Fax (516) 765-1823
=__',yol �1�rr6 Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT •
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3134-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner MCDERMOTT, JOHN
Mailing Address 1 8530 PECONIC BAY BLVD.
Mailing Address 2
City St Zip LAUREL NY 11948-0000
Property Address 1 8530 PECONIC BAY BLVD.
Property Address 2
City St Zip LAUREL NY 11911.8-0000
Owner Telephone No. 516-298-8861
Tax Map No. section 126.00 block 11 . lot 22.000
Cross Street BRAY AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 10/14/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK �cilVFU(,Y'-
Town of Southold Z
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CQ - Application No.S 1 3 q
Judith T. Terry, Town Clerk . ,�- ,
Town Hall, 53095 Main Road a E -i -'� 7 $10.00 - Residential
P. O. Box 1179 cn , 3 M; $25.00 - Non-Residential
Southold, New York 11971 O $
4:9144'"i°-....
Telephone
•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAE' f3:ISIRICT .,,_„�
RECEIVED
APPLICATION
SEP 3 0 1993
for
Southold Town Clerk
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE T. 0th ' 5 3
OWNER NAME: JI c 1.) /C/40.1-1---
OWNER
.) /C/40OWNER MAILING ADDRESS: tJ 5O %ctyYtic /37u 'of
A.Po rel k, . ///$1
OWNER PROPERTY ADDRESS: a 40.�..
OWNER TELEPHONE NUMBER: \[/j, - �g f- ft 6 I
TAX MAP NO. : Section J`]4 Block // Lot -/"/
CROSS STREET: �e`fwe/e-m, fa /Yl we"�9' alid i5.s- ire ah easdr
TYPE OF .SYSTEM: Septic Tank __ New Existing
Cesspool New Existing
Residential 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.)
J / Q1
Signature of Applica t
OP
RECEIVED BY: ' -
Town C erk's Office
DATE: q ' � , - 4( 3
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L r TITLE NO.S-55572
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SURVEY FOR -
JOHN J. & ARABELLA S. McDERMOTT -
MATTITUCK
• TOWN OF SOU THOL O
SUFFOLK COUNTY, N.Y. .
-
GUARANTEED TO:
. TITLE DIVISION CH
, TIITMLE E INSURANCE COMPANY.O
IIS SCALE: I 50 JOHN J.a ARA BELLAS.MCDERMOTT
OCT 19, 1966 _
OCT 21, 1966 e,.�. - Q. ,v
- LAND SURVEYOR •
NOTE: ' N.Y.S. LIC.NO. 28725
0= MONUMENT RIVERHEAD,N.Y. ,