HomeMy WebLinkAboutFlatley JUDITH T. TERRY Town Hall, 53095 Main Road
P.O. Box 1179
TOWN CLERK R' Southold, New York 11971
REGISTRAR OF VITAL STATISTICS r� ���`` Fax (516) 765 1823
MARRIAGE OFFICERy .�
`4® �� 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. 1884-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner FLATLEY, WILLIAM T.
Mailing Address 1 BOX 363
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 WOODCLIFF DRIVE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-4451
Tax Map No. section 107.00 block 8 lot 16.000
Cross Street BROWERS ROAD
Date Of Last Pump Out 0/00/84
Issue Date: 4/20/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK ic�VFFO(i'°/-
Town of Southold Application No. "OPfr'
Judith T. Terry, Town Clerk � $10.00 - Residential
Town Hall, 53095 Main Road o '
P. O. Box 1179 CS3 �t � $25.00 - Non-Residential
Southold, New York 11971
Telephone : .�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE > /7 /9��
OWNER NAME: /r/,z4a,xe '7. A-74LE/
OWNER MAILING ADDRESS: 604" 3�5
01777 y
- -_-- _._ -- - - OWNER-PROPERTY ADDRESS: In9®D�LIa",e-. 7J�_... --- -- - — _ -
,v14. `y?-a i/y //9�v
OWNER TELEPHONE NUMBER: Ape-1/4<c/
TAX MAP NO. : Section /� 7 Block c' Lot /✓
CROSS STREET: ,e5,1.ele7,0 Re:9'50
TYPE OF. SYSTEM: Septic Tank New Existing
Cesspool V New Existing r/
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: /9e /
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 .f Applicant
RECEIVED BY: )1-e-g.‘e,9
own Clerk's Offic
DATE: APR 2 0199?
Town Clerk Smite
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