HomeMy WebLinkAboutMagill OFFICE OF THE TOWN CLERK '
Town of Southold Q j
Judith T. Terry, Town Clerk �
Town Hall, 53095 Main Road _ a3
P. 0. Box 1179 tri zz !VW: �•
Southold, New York 11971 •�
Telephone _ ,(
(516) 765-1801 _
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 165 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: Richard Magill
OWNER MAILING ADDRESS: RR 1 . Box 28A, Bray Avenue
Laurel. New York 11948
OWNER PROPERTY ADDRESS: Bray Avenue
Laurel. New York
OWNER TELEPHONE NUMBER: 516-298-9658
TAX MAP NO. : Section 126 Block 2 Lot 14
CROSS STREET: Route 25
TYPE OF SYSTEM: Septic Tank X New Existing x
Cesspool X• New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Septemher 79• 1986
ereedstee0;100770:4„
Judith T. Terry
Southold Town Clerk
DATE: December 4, 1986
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(TO'WN SEAL),
OFFICE OF THE TOWN CLERK o�UFF�(�.�'- //
Town of Southold �� CQG'_ Application No./ t�
Judith T. Terry, Town Clerk `'t2;,22:4
�-. =r < � Residential e
Town Hall, 53095 Main Road F, ,,, 14
P. O. Box 1179 crs , Non-Residential
Southold, New York 11971 O*��`
Telephone Alt /IPT
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.�� 5
Fee $ 10 , 00
DATE /C70ep
OWNER NAME: Pi' [? ka_r d 46 9' if
_.J
OWNER MAILING ADDRESS: ,R1Q I. Dx a gni
, ,V Y 119 cie �J
OWNER PROPERTY ADDRESS: ,k3 t i (J ,4 L'e L a_L re
OWNER TELEPHONE NUMBER: 9F-- 96 S 4
TAX MAP NO. : Section Block Lot //
CROSS STREET: C�( l c 23
TYPE OF SYSTEM: Septic Tank X New Existing X
Cesspool New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: 9/19/&
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.)
Signatur f Applicant
RECEIVED BY: mac_ (/
Town7Clerk" Office
DATE: RECEIVE®
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