HomeMy WebLinkAboutMcdonnell OFFICE OF THE TOWN CLERK ' c0FOUt/F
Town of Southold �lj
Judith T. Terry, Town Clerk � �E�.47 :Y 2
Town Hall, 53095 Main Road 8 - y
P. O. Box 1179 •
Southold, New York 11971Lo �0�-�
Telephone /
(516) 765-1801 ' p'"
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 247 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: Frederic D. J. McDonnell and Teresa McDonnell
OWNER MAILING ADDRESS: Rt. 2, Box 110. Clark Road
Southold, New York 11971
OWNER PROPERTY ADDRESS: Clark Road
Southold, New York
OWNER TELEPHONE NUMBER: 516-765-1608
TAX MAP NO. : Section 51 Block 3 Lot i q
CROSS STREET: North Road
TYPE OF SYSTEM: Septic TankX New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: February 20_ 1987
•
Judith T. Terry
Southold Town Clerk -
DATE: March 31 , 1987
(TOWN SEAL)
'C/ // /II Ii
OFFICE OF THE TOWN CLERK MFFDCA-I
Town of Southold �� _ - - -CG',. Application No1
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road gtir Residential
P. O. Box 1179 cn * . Non-Residential
Southold, New York 11971
Telephone : 1 ,
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. S"l®. - i7
Fee $ /de Ott
DATE .3o/F'7
OWNER NAME: f AIEPE/ZIC ;` Q" /G- /e-Reic 4- , cDo vjv 4L
OWNER MAILING ADDRESS: :�, Roy //O c-/-ibex. R ,I' •
So u-p OLS AA-Mt,OgA I /97/
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: 416/-74-r---/ r
TAX MAP NO. : Section 4-C1 Block 2 Lot
CROSS STREET: tiro / (
TYPE OF SYSTEM: Septic Tank /O New Existing
Cesspool New Existing
Residential jj� Non-Residential
DATE OF PREVIOUS PUMP-OUT: 3--/P-'®/ '7
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.)
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N �--� ! t/0/$el
• • At1LyflLt�
_ Signature of f pplicant
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RECEIVED BY: '
REM n Clerk's ffice -
DATE: IY1I R 3 01987
-- Town Clerk Southold