HomeMy WebLinkAboutMalone e',.., ' . s'*k‘
r �� Town Hall, 53095 Main Road
`_® I P.O. Box 1179
`��Q( `��® o, Southold, New York 11971
JUDITH T. TERRY —��������I�gIII TELEPHONE
TOWN 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. 1051-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner MALONE, HOWARD F.
Mailing Address 1 250 BLUE MARLIN DRIVE
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 250 BLUE MARLIN DRIVE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-9210
Tax Map No. section 56.00 block 7 lot 21 .000
Cross Street DOLPHIN DRIVE
Date Of Last Pump Out 0/00/00
Issue Date: 3/15/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK c§WFOL,(' =
-- ''Town of Southold �� C
Judith T. Terry, Town Clerk y. , "`� :� Application No. /0 S
~ ~ ` 4 1
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Town Hall, 53095 Main Road o :� . Residential
P. O. Box 1179 v' 'h. moi ; Non-Residential
Southold, New York 11971
Telephone OjiNd s�
(516) 765-1801
TOWN OF SOUTHOLD
•
•
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee '$ •
• ' DATE ISr
OWNER NAME: ftl L0/..3 6- ) )/D Gw 4,e f F.
OWNER MAILING ADDRESS: 2-CD 51_0 E1L//J
4.570077 1-6 N .y, 1/ 97)
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: ( iJ 7GS C7 Z / c
•
TAX MAP NO. : Section ,..5r(7 Block - 7 Lot z- •
+ .
CROSS STREET: 3 L.t)I- ISI i4(L L(d) q b d LPI-1-113 D i I/E(S)
TYPE OF SYSTEM: Septic Tank ,( New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: 3
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.) •
•
Signature of A• itlicant
•
RECEIVED BY: •
own Clerk s Office
DATE: /,C4,
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