HomeMy WebLinkAboutFagan /101`
.: '` }> _-> t; Town Hall, 53095 Main Road
- P.O.P.O. Box 1179
_ ®d ��®��� Southold, New York 11971
JUDITH T.TERRY "-���,,,y�z%���I' FAx(516)765-1823
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. 1229-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New X Existing
Name Of Owner FAGAN, WILLIAM AND DOLORES
Mailing Address 1 P. O. BOX 583
Mailing Address 2
City St Zip LAUREL NY 11948-0000
Property Address 1 9250 NEW SUFFOLK AVENUE
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-7881
Tax Map No. section 116.00 block 4 lot 3.001
Cross Street DEAN DRIVE
Date Of Last Pump Out 0/00/00
Issue Date: 8/25/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
/
OFF,'CE OF THE TOWN CLERK cwVFD
Town of Southold �® ter_ ® _',. Application No. ,a.�9
Judith T. Terry, Town Clerk -
Town Hall, 53095 Main Road i Residential
p. O. Box 1179 U' V • Non-Residential
Southold, New York 11971 ®'�
Telephone o.1 )*;
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION '
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE AtIrtc7 2 -, /6/kg
OWNER NAME: J7///,q 9- joy es IR 9,,744
OWNER MAILING ADDRESS: 17 0, ,, k 8�
/ urc/3 V fl9zlr
OWNER PROPERTY ADDRESS: q� 49 A/47,,A,' S( l ,19✓'e
o5et E. 4X /09_.7s—
OWNER TELEPHONE NUMBER: f/4
TAX MAP NO. : Section 1/6 Block V Lot Cj,.
CROSS STREET: YeAii Prtive
TYPE OF SYSTEM: Septic Tank ✓ New r Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: 447,, �2�59',//7 jr,,'l
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.)
- igna ur of Applicant
RECEIVED BY:
W \
02 (it
Town Clerk's Office
DATE: s
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