HomeMy WebLinkAboutMckiernan _..9 ,'� OS�FFO(�co
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JUDITH T.TERRY ��� y1 Town Hall, 53095 Main Road
TOWN CLERK ; y _ P.O. Box 1179
w T t Southold,New York 11971
REGISTRAR.OF VITAL STATISTICS :�� • S ' Fax(516)765-1823
MARRIAGE OFFICER ; 0l 111,10'i Telephone(516) 765-1800
RECORDS MANAGEMENT OFFICER - l [
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No, 3476-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner MCKIERNAN, MATTHEW & JOSEPHINE
Mailing Address 1 P. O. BOX 1637
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 62175 COUNTY ROAD 48
Property Address 2 •
City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 516-477-2984
Tax Map No. section 40.00 block 1 lot 2.000
Cross Street CHAPEL LANE
Issue Date: 6/14/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
.,.'.
OFFICE OF THE TOWN CLERK �S\FFO(,r�'=
t ' Town of Southold
i
C'
4 - Application No.L.3
Judith T. Terry, Town Clerk .� h �►
Town Hall, 53095 Main Road a ; . $10.00 Residential
P. 0. Box 1179 �, ,i'.-; '.:••'`..•"_::, *r `- $25.00 - Non-Residential
Southold, New York 11971 O /�`
Telephone _ .(
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE j'j- / 6
OWNER NAME: /,►'9'7;4et9.���SF 1J�..i 43 ''/— e'er
eY,v' 19A)
OWNER MAILING ADDRESS: O B®>. /6g7
L5 1' -170 l41, AJV 7/ 971
OWNERPROPERTY ADDRESS:-64/7r. ,/t/'jjd�1e /?d ( cry to fir)
GP-eei rp ., 119�1--
OWNER TELEPHONE NUMBER: (5—/6) 4177 21V
TAX MAP NO. : Section p 410 Block / Lot
CROSS STREET: 0 h#p c 9 4, AJ , ,
TYPE OF SYSTEM: Septic Tank �. New l'°\ Existing
Cesspool )`--- New 7c., Existing
Residential Non-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.)
��
0,-, , �4 /1------ ---:-----
Signature of APp'li4ant 7RECEIVED BY:
.6
own Clerk's Office
DATE: >/M
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SUFFOLK CO HEALTH DEPT.APPROVAL !
H.S. NO. it
:=Tt• �:c. air;lr4,-,? -- -__._ . - - _ L4 ti \ SINGLE FAMILY DWELLNG ONLY
.,(_-______________,____-_______,._4'o _ E PIKES THREE YEARS FROM DATE OF APPROVAL,I 1
r 1 sI SIt7'W , 4
al"ZES1 •, 1� :f q`} `a,,, _ t I ' I I I STATEMENT OF INTENT - • IQ
• \ } ,/,,bc,.6 -c•/- 1114x,) L_.___i ,S.e-,o_ •` - 1 i 's13 . 1 ' 1 - THE WATER'SUPPLY AND SEWAGE DISPOSAL IN
/ j I - I l I • Jjj 6 r? a{ ' 1 • j SYSTEMS FOR • THIS "RESIDENCE•- •WILL,I
1I - S;¢ .•43,.0-A - ' -‘---ry 1 4440 do•^c� ;_ S �f' I .{43- I I, CONFORM':•_.THE •TANAAI2D :•F 'THE-
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• " '{ . = -77",„7-7,7,---r- --, ti + ' i - I t SUFFOLK LH':ir`,�S VICES,
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4 t ��0 • (,' BI, , t SERVICES -'FOR APPROVAL FOR
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