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Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
JUDITH T.TERRY ��� �.r���`�� FAX(516)765-1823
TOWN CLERK TELEPHONE(516)765-1801
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. 1550-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner MCGAHAN, MARY S.
Mailing Address 1 1400 WEST CREEK AVENUE
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 1400 WEST CREEK AVENUE
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-5472
Tax Map No. section 110.00 block 1 lot 4.000
Cross Street MIDWOOD ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 10/23/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
I III '
OFFICE OF THE TOWN CLERK �c3VFFCurC''
Town of Southold � ��'• Application No. /67..5-t
Judith T. Terry, Town Clerk x,a L ; y
Town Hall, 53095 Main Road ,< :, $10.00 - Residential
P. O. Box 1179 cr�� rr'wry , `
, $25.00 - Non-Residential
Southold, New York 11971 O� _ �o���`
Telephone ,(
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL •
Operation Permit No.
Fee $ fD O-o
DATE ®GT 9) 1998
'OWNER NAME: MA-P4/ 5, / C '411-4A/ •
OWNER MAILING ADDRESS: /, '4-(51-t) C&9e_ D9-/rre
C Irc l,F®gue; NY /19��
OWNER PROPERTY ADDRESS: $fit
OWNER TELEPHONE NUMBER: ,_5-4(6 - 7 t(_ ,-
TAX MAP NO. : Section //O Block / Lot cl
CROSS STREET: M(pGU6idi) fel),
TYPE OF SYSTEM: Septic Tank f New Existing .�
Cesspool New Existing
Residential 1/ Non-Residential
DATE OF PREVIOUS PUMP-OUT: 1469/90
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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i®� e 4
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
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Guarantees Indicated hereon shall run �L�E C 7 ,5 C ---'— / ^ N Garty to the person for whom rho survey f� i� r.,•-,,,. ! ." ' (Tc).(`°;,1
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• Union.Guarantees ere not transferable
to ea:Missed institutions®r subsequent �L APdD
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