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JUDITH T. TERRY
Town Hall, 53095 Main Road
TOWN CLERK O i
P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER
XV), 0 Fax (516) 765-1823
,r., �® �! Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1840-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner MCFANN, E. AND LUNDEN, D.
Mailing Address 1 C/O DORTHY DALY
Mailing Address 2 1745 BAYSHORE ROAD
City St Zip GREENPORT NY 11944-0000
Property Address 1 1745 BAYSHORE ROAD
Property Address 2
City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 516-477-1936
Tax Map No. section 53.00 block 4 lot 7.000
Cross Street KERWIN BLVD.
Date Of Last Pump Out 0/00/81
Issue Date: 2/12/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
r • -
OFFICE OF THE TOWN CLERK s• COFUL '
Town of Southold NeCQ ' Application No./ S��d
Judith T. Terry, Town Clerk �` *`"` �► r/
Town Hall, 53095 Main Road -- $10.00 - Residential
a
P. O. Box 1179 tri "; t 4 ► ; $25.00 - Non-Residential
Southold, New York 11971 O ` e�
Telephone ( Y►O
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /a(
• DATE ••////9
OWNER NAME: 144 C.V-Zvty `14 D S2-4u-1,--/Zoir
OWNER MAILING ADDRESS: / 7 S15- / ? I
OWNER PROPERTY ADDRESS: j .ker.?
OWNER TELEPHONE NUMBER: _676 / 7 — l9
TAX MAP NO. : Section 3'-E Block V Lot
CROSS STREET:
8,1,-)1A
TYPE OF SYSTEM: Septic Tank- •1` New Existing
Cesspool New Existing
Residential p( Non-Residential
DATE OF PREVIOUS PUMP-OUT: CL IO
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.)
aNgnature of09,116.—
plicant
RECEIVED BY: N', /
Town Clerk's Office
DATE: - ////l i..