Loading...
HomeMy WebLinkAboutMcneill % ‘04'7- "‘ Town Hall, 53095 Main Road P.O. Box 1 179 `1 2 • ��`i��, Southold, New York 11971 -ttJUDITH T.TERRY _®� E ° �� TELEPHONE rowN CLERK !���/ (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. 865-R Residential X Non-Residential Fee $ 10. 00 Septic Cesspool X New Existing X Name Of Owner MCNEILL, DONALD Mailing Address 1 BOX 2060 Mailing Address 2 City St Zip ORIENT NY 11957-0000 Property Address 1 1380 VILLAGE LANE Property Address 2 City St Zip ORIENT NY 11957-0000 Owner Telephone No. 516-323-2555 Tax Map No. section 25. 00 block 1 lot 27. 001 Cross Street ORCHARD STREET Date Of Last Pump Out 0/00/00 Issue Date: 9/28/88 Judith T. Terry Southold Town Clerk (TOWN SEAL) •• Q OFFICE OF THE TOWN CLERK �C3\\ D� p Town of Southold � Application No.d ` c� Judith T. Terry, Town Clerk �` x- 4 4 <. Town Hall, 53095 Main Road )' 11 Residential cora w P. O. Box 1179 S : ms Non-Residential • e . Southold, New York 11971 Q ® '`� �.0�,•�� Telephone 4Q(Y' �� • (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ • DATE 7/4 OWNER NAME: e� t1 aid ole_ N/eeYr OWNER MAILING ADDRESS: / o/ey 1,o6 . OWNER PROPERTY ADDRESS: / 3 S'o kr,` itc f 9 �4,1.v Oe yf OWNER TELEPHONE NUMBER: 3 - 7._3 SP 1� , TAX MAP NO. : Section 'L.5 Block / Lot 1 / . / CROSS STREET: TYPE OF SYSTEM: Septic Tank New Existing Cesspool New Existing Residential / Non-Residential DATE OF PREVIOUS PUMP-OUT: ‘, // q f 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.) A-Lc,_ 4 Signature pplicant IMMO RECEIVED BY: 111- 4grk's Office DATE: C edt S®iti.,®U� e e I I • 4.2P 2 S,7_ f I$r el' 13g© V, rIG.. � e