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Home My WebLink AboutReilly io 40 G : JUDITH T. TERRY ' i► Town Hall, 53095 Main Road TOWN CLERK t P.O. Box 1179 REGISTRAR OF VITAL STATISTICS to . Southold, New York 11971 �✓ �� MARRIAGE OFFICER Fax (516) 765-1823 � ® ®�" � �,y®1 1P,01 Telephone (516) 765-1801 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 144-N Residential Non-Residential X Fee $ 25.00 Septic Cesspool X New Existing X Name Of Owner REILLY, R. & BLOCK, R. Mailing Address 1 P. O. BOX 1494 Mailing Address 2 City St Zip MATTITUCK NY 11952-0000 Property Address 1 LOVE LANE Property Address 2 (MATTITUCK LAUNDROMAT) City St Zip MATTITUCK NY 11952-0000 Owner Telephone No. 516-298-4651 Tax Map No. section 140.00 block 3 lot 3.001 Cross Street PIKE STREET Date Of Last Pump Out 0/00/00 Issue Date: 9/23/93 Judith T. Terry Southold Town Clerk (TOWN SEAL) OFFICE OF THE TOWN CLERK oc�vFFD(,( '- (� / Town of Southold � CQ ' Appli cation-No/ �r Judith T. Terry, Town Clerk AV Town Hall, 53095 Main Road o a ?�y�yx I $10.00 - Residential P. O. Box 1179 r-n $25.00 - Non-Residential G/ Southold, New York 11971 O %'4•41e.Telephone • (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ QS, DATE g- ,r2 - 93 OWNER NAME: /e igr//4./ / ,e, OWNER MAILING ADDRESS: �« � - 9-9_ T y OWNER PROPERTY ADDRESS: Z�jx /49.1 OWNER TELEPHONE NUMBER: LC/ --f4 S / TAX MAP NO. : Section / yc, Block _ 3 Lot , CROSS STREET: ?7 / C v9) 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 of distance, approximately, to building and closest road.) 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