HomeMy WebLinkAboutMacdonald (2) etd .04
Town Hall, 53095 Main Road
P.O. Box 1179
_ i ��� Southold, New York 11971
JUDITH T.TERRY
® �� FAX(516)765-1823
'_��� �y� i
TOWN CLERK TELEPHONE(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. 1043-R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
New Existing X
Name Of Owner MACDONALD, NEIL J., SR.
Mailing Address 1 770 VILLAGE LANE
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 770 VILLAGE LANE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-4420
Tax Map No. section 114.00 block 6 lot 17.000
Cross Street ROUTE 25
Date Of Last Pump Out 0/00/00
Issue Date: 3/08/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK 'cOFOU.�'= ( i/3 Town of Southold Q CQG' Application No. 70 V 3
Judith T. Terry, Town Clerk .` :� r ` �'=`% ��'� Residential
Town Hall, 53095 Main Road cs
cn "" :'-y ^'• i z Non-Residential
P. O. Box 1179 ���'.= �{ ..:�; ��
Southold, New York 11971 ® '. , ��`
TelephoneAA
(516) 765-1801
TOWN OF SOUTHOLD
•
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /Q.
DATE .3- 6 - S9
OWNER NAME: /Va.-Y.& fi 4 c� s/e .
- � e�d
OWNER MAILING ADDRESS: `7 7 0 Viz- 6-A C- fer
s,- 7"7 , 7-&O . / / 9 5-a
OWNER PROPERTY ADDRESS: ' 7 7 0 V; L.. [. /9 Z. ,4 A0��'
1" X1,1'7- 777—COGN•y, / / 9 a.
OWNER TELEPHONE NUMBER: si 8 - 542. 0 r
TAX MAP NO. : Section / / Block Lot /
CROSS STREET: R TIE a .5-
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool \/ New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: 10(.1d0,57- Z7— / pig
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.)
•
/Air en"-sAg-Jt-
signature of Applicant
RECEIVED BY: .
Town Clerk's Office
. DATE:
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