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HomeMy WebLinkAboutFlanagan fO k s <3 Town Hall, 53095 Main Road � r�; P.O. Box 1179 =_4/1 ,i" Southold, New York 11971 JUDITH T.TERRY `= %% ••• FAX(516)765-1823 TOWN CLERK TELEPHONE(516)7654801 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. 1470-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner FLANAGAN, MARY Mailing Address 1 1430 CONKLIN ROAD Mailing Address 2 City St Zip MATTITUCK NY 11952-0000 Property Address 1 3825 WICKHAM AVENUE Property Address 2 City St Zip MATTITUCK NY 11952-0000 Owner Telephone No. 516-298-8567 Tax Map No. section 107.00 block 9 lot 5.000 Cross Street MARY ROAD Date Of Last Pump Out 0/00/00 Issue Date: 5/30/90 Judith T. Terry Southold Town Clerk (TOWN SEAL) OFFICE OF THE TowN CLERK Town of Southold Q C'� Application No.1� Judith T. Terry, Town Clerk �,- l/ 0-- .41tat �1 $10.00 - Residential �`- Town Hall, 53095 Main Road .y N ? `K sr wn P. O. Box 1179 cn� � ot, �� $25.00 - Non-Residential Southold, New York 11971 Q ® - �'0���` Telephone '�( Xit `g° (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ , ( _ DATE 61/4 /4 OWNER NAME: 7/92,11R7 r�. ,qiy 7 41/✓ OWNER MAILING ADDRESS: / .3O aviri,in/ ,&1 Afrr/ rock iv l/ Pp-2- OWNER PROPERTY ADDRESS: $ cr 10 6.4,1,1 �f pyt- ( ,i) Thhirr -roc/T OWNER TELEPHONE NUMBER: .7 J'_ 9.5-47� 1 TAX MAP NO. : Section /07 Block g Lot CROSS STREET: /V,,,7 ,P6 I) TYPE OF SYSTEM: Septic Tank New Existing Cesspool V New Existing 1/-- Residential Residential ✓ Non-Residential DATE OF PREVIOUS PUMP-OUT: ,&?e) .,4 /7,6 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.) 194;/2-ef SignatRV-7— of Applicant • RECEIVED BY: , wn lerk's Office DATE: Z' C2 ury. ;f ., LCA/70 Cree A i----- 4./ Pitiiii ;,, I x44411 , 1 / aicrkt q�,,y ,11 Cess o0 ljs 7,1,1111-1. all I -4 r'iIT �' i) . Cosspoo/ /0 Ca lion :YgF.,` / f r©mer i O. 7� ,qV, I 382 Mary r/onc0CJCi-/7 j i P,', f VVic thorn 4vC # 5 /O 7 — '— .i.; ; 0,v tori ! I- — — 0 ,,ovi'c t1 rr'§�t J or Vii{a, ;, ' .i Mlif4 ' 'I i\irl'--- - m it , Y v t,; ; ,,i19P!r ,'7,i1t I;