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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK CM
Fri
P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER �Q O� , Fax (516) 765-1823
'W Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 2042-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner MCKINNEY, JULIE L.
Mailing Address 1 BOX 1632 -
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 7373 SOUNDVIEW AVENUE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-9235
Tax Map No. section 59.00 block 9 lot 26.013
Cross Street KENNY'S ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 2/22/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK c.0FD(,i-
Town of Southold % ,-- C2'.. Application No.c2f�
Judith T. Terrry, Town Clerk . �►
_� ; -4 IP .0 1 $10.00 - Residential
Town Hall,' 53095 Main Road r
P.O. Box 1179 v' ,V,:: Khp.' Z $25.00 - Non-Residential
Southold, New York 11971 O0 �0�,•�`
Telephone 1 r
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
' OPERAT ION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ j0 ,
2. _
DATE Z S G.J
OWNER NAME: J U''8.. 1 F L, fAc`tf lu P Er
OWNER MAILING ADDRESS: .C)x. I 6 0 2
.&-'0 0700L6 toy WO l
OWNER PROPERTY ADDRESS: 1. .. eio t//�[jJ liV
OWNER TELEPHONE NUMBER: %S _ 2 3S
TAX MAP NO. : Section Block Lot ., ./ ,�I i i3
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool 7 New Existing 10
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: / 21/1 7 2/.
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.)
7 i& (3 / 1 C-44.."---(62 '
Signature of Applicant
RECEIVED BY: .(A.A /,����
Tow Clerk's Office
DATE: /7.2
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