HomeMy WebLinkAboutMacleod Town Hall, 53095 Main Road
`` P.O. Box 1179
_ ®n �� Southold, New York 11971
FAX(516)765-1823
JUDITH T.TERRY "
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. 949-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name-Of Owner MACLEOD, THOMAS AND BARBARA
Mailing Address 1 2105 CAMP MINEOLA ROAD
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 TRACK ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-298-5428
Tax Map No. section 137.00 block 1 lot 21 .000
Cross Street STILLWATER AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 12/09/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
• ...
OFFICE OF 'THE `'TOWN CLERK 'c�� �FD(,I'�
Town of Southold � ,: C'0 Application No. 9�f
Judith T. Terry, Town Clerk �` xFi`�i ,i _ -
Residential /
Town Hall, 53095 Main Road a h
b j i �J�x4 -
P. 0. Box 1179 cn :. � 4i ;' Non-Residential
Southold, New York 11971
Telephone it
(516) 765-1801
TOWN OF SOUTHOLD
•
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
. OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 41. 47/7
Fee $
DATE Ad- /9 / 98c?
OWNER NAME: 7f S 7-- 80-rkr oi 9-GL e d
OWNER MAILING ADDRESS: 621Oc C a/y 77) e0fQQ kg
ikc.� /'1 �/ . ( (`9s 2�
OWNER PROPERTY ADDRESS: J,fQ1 d .
«frAosoi�
OWNER TELEPHONE NUMBER: cP.qe— af -- {
TA)&MAP NO. : Section / 37. ° Block O 1 .0° Lot 0a• / . 0
CROSS STREET: „a-fit/ t o f ,4v
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool - / New � Existing
Residential / Non-Residential
DATE OF PREVIOUS PUMP-OUT:
LOCATION MAP: Must be attached hereto before permit may be issued. ?
(Locate building and system; give north arrow and feet (( On
of distance, approximately, to building and closest road.) 0 bckc /c.
•
•
Signature of Applicant
RECEIVED BY• ,„., , ,., 1�
n Clerk's Office
DATE: DEC 0 91988
town aed Saadi
-
/ 7-1'
1•3
P I
-2
-(7
Ithis
0 _9- s\•3
/f../ (IN
tr
(,)
it
L
/ ,
1
1
bte
I")-'