HomeMy WebLinkAboutMckasty 1,I0W 4
JUDITH T.TERRY `�� �� Town Hall,53095 Main Road
TOWN CLERK c® g P.O.Box 1179
•
•REGISTRAR OF VITAL STATISTICS Southold,New York 11971
MARRIAGE OFFICER Fax Fax(516)765-1823
RECORDS MANAGEMENT OFFICER �� �i ,I0' Telephone(516)765-1800
FREEDOM OF INFORMATION OFFICER ,o
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3311.5-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner MCKASTY, JOHN AND JAY A.
Mailing Address 1 P. O.BOX 207
Mailing Address 2
City St Zip ORIENT NY 11957-0000
Property Address 1 205 OLD FARM ROAD
Property Address 2
City St Zip ORIENT NY 11957-0000
Owner Telephone No. 516-323-1309
Tax Map No. section 25.00 block 5 lot 6.000
Cross Street ORCHARD STREET
Issue Date: 6/01/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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'OFFICE OF THE TOWN CLERK ,���FOU,�'-
Town of Southold ® •, CQG Application NoJ`3��
Judith T. Terry, Town Clerk .` > , .e...11.\
Town Hall, 53095 Main Road w°,tx' �
... ! $10.00 - Residential
P. 0. Box 1179 to -. = _ ; $25.00 - Non-Residential
Southold, New York 11971 O x ' 4 �s`�
Telephone N.a' '.�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE Il O I9 16, l-
OWNER NAME: 00140 1 3-W a„ Mme * )l)
i
OWNER MAILING ADDRESS: ,()b (3oK L
(Dal/ ii ki51
OWNER PROPERTY ADDRESS: b-) (D/4 J&yn r(-40
farA ,P j
OWNER TELEPHONE NUMBER: j /4� --3 -.1_'"- - I-3t�
TAX MAP NO. : Section 25 Block 5 Lot le
CROSS STREET: ?j {-1 z) C�-C-er
TYPE OF SYSTEM: Septic Tank X New Existing X
Cesspool New Existing
Residential XNon-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.)
��ti" 1
Signaure of Applicant
RECEIVED BY:
RecMa Clerk's Office
DATE: , ' JUN 1 1995
sown Clerk Soda ,
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PATE JUN l i 1985 . D. . # i �a.2.54/ - - 1
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The seae� disposal water ettpp� _ ,
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