HomeMy WebLinkAboutMcnulty OFFICE OF THE TOWN CLERK • cOFQ[x`,"
Town of Southold
Judith T. Terry, Town Clerk ; *
Town Hall, 53095 Main Road - '
P. 0. Box 1179 •
Southold, New York 11971 Q ® ' ;,�,-
,
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Telephone __®1 •
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 137 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: Frank J. McNulty
OWNER MAILING ADDRESS: P.O. Box 112
Laurel, New YOrk 11948
OWNER PROPERTY ADDRESS: 9;5 Peconic Bay Blvd.
Laurel, New York
OWNER TELEPHONE NUMBER: 516-298-8383
TAX MAP NO. : Section 129 Block 1 Lot 2
CROSS STREET: Laurel Lane
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: 1981
•
Judith T. Terry
Southold Town Clerk
DATE: November 10, 1986
(TOWN SEAL) -
OFFICE OF THE TOWN CLERK �OFO
Town of Southold �®� , =. `QG Application NoP7
Judith T. Terry, Town Clerk g `''
Town Hall, 53095 Main Road � n � ` Residential
P. O. Box 1179 •
cn moi. � .
N Non-Residential
-
Southold, New York 11971 O i ®� e.
Telephone %.71®1 4i ��
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OV 10 `
OPERATION PERMIT
Ton Ce WNW
SEPTIC TANK or CESSPOOL
Operation Permit No. /37
Fee $ /,0
v
DATE
OWNER NAME:
Po 6 //-
OWNER MAILING ADDRESS: iirA ►1 r ij
OWNER PRO, ,ERTY ADDRESS: /�i��
CC'S - ai 8&4igo `�
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CSC Glt/Ltcc/ ,�
OWNER TELEPHONE NUMBER: r
TAX MAP NO. : Section /7 9 Block / Lot
CROSS STREET: a.x.-eitzi,
TYPE OF SYSTEM: Septic Tank • New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: �J
LOCATION MAP: Must be attached hereto befor permit may be ' sued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
- 714//a
Signaturlf Applicant
RECEIVED BY:
Town CI rk's 04-fie
DATE: � j JO , / ,A•
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