HomeMy WebLinkAboutFanning 410 CAC r CD;
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Town Hall, 53095 Main Road
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Vii`,` P.O. Box 1179
®1 �• iF Southold, New York 11971
JUDITH T.TERRY 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. 1006-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner FANNING, HELEN L.
Mailing Address 1 1140 MARLENE LANE
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 1140 MARLENE LANE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-11852
Tax Map No. section 144.00 block 2 lot 39.000
Cross Street MAIN ROAD
Date Of Last Pump Out 5/00/86
Issue Date: 2/07/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK 'c.0FD(i�
Town of Southold Q r _ .-,��G�, Application No. /OO,6
Judith T. Terry, Town Clerk Y .r y
Town Hall, 53095 Main Road a � :'� Residential
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P. O. Box 1179 cry :�;.r,•.� -, �,. � Non-Residential
Southold, New York 11971 •�`�
Telephone : ,(
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
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APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. ,OO(2
Fee $ /O
DATE ;---/7/f7
OWNER NAME: ���jf, �2r
OWNER MAILING ADDRESS: /i �
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OWNER PROPERTY ADDRESS: c l'?
OWNER TELEPHONE NUMBER: ,.,2 9 F.:- fLS
TAX MAP NO. : Section /1/2/ Block 2 Lot 37 •
CROSS STREET: //'e,
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ✓ New Existing
Residential ✓ Non-Residential
DATE OF PREVIOUS PUMP-OUT: e(�
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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Signatu 'e of . pplicant
RECEIVED BY:
Town erk's Of ice
DATE:
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