HomeMy WebLinkAboutMckenna OFFICE OF THE TOWN CLERK •
Town of Southold �OC� FF�[ `+c• -
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road
P. O. Box 1179
Southold, New York 11971 p • ••
Telephoner
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
•
Operation Permit No. 245 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: Daniel W. McKenna
OWNER MAILING ADDRESS: RD 3-, Minnehaha Blvd.
Southold. New York 11971 •
OWNER PROPERTY ADDRESS: Minnehaha Blvd. •
Southold. New York
OWNER TELEPHONE NUMBER: 516-765-4965
TAX MAP NO. : Section $7 Block 3 Lot 14.1
CROSS STREET: Corner of Minnehaha Blvd. and Minnehaha Myr!_
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: _12/24/86
Judi . e . •
Southold Town Cle
DATE: March 31 1987
(TOWN SEAL)
OFFICE OF THE TOWN CLERK ��S\FFO(/rCG'
Town of Southold 0Q : Application
Judith T. Terry, Town Clerk . 0 .
Town Hall, 53095 Main Road c �� : Residential
P. 0. Box 1179 v' tftNon-Residential
Southold, New York 11971 451°14-i -...
�O• -•
Telephone l s '.
(516) 765-1801
TOWN OF SOUTHOLD
?P SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /per
DATE
OWNER NAME: ` /074,/.147,1f
OWNER MAILING ADDRESS: *4; 4f Q/,,9 ,� $, /1�
a A./(,j , //17/
OWNER PROPERTY ADDRESS: // /,v.U'44 9/,q , f4{27
OWNER TELEPHONE NUMBER:
TAX MAP NO. : Section /7 Block � Lot /.` . /
CROSS STREET: ve.le
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool 10 New Existing !9
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: /2�',/JJ
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.)
S•'•nature of Applicant
RECEIVED BY:(a( •
RECEIV hwn CI k's Office
DATE: BAR 2 7 1QQ7
Town Clerk Southold
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