HomeMy WebLinkAboutGallagher OFFICE OF THE TOWN CLERK ' SgFUCk�►'
Town of Southold �. �G
Judith T. Terry, Town Clerk %
Town Hall, 53095 Main Road •-•• -
P. O. Box 1179
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Southold, New York 11971 �•
Telephone =�j *
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 262- Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool X
NAME OF OWNER: Francis Gallagher •
OWNER MAILING ADDRESS: 9090 Chrysanthemum Drive
Boyton Beach, Florida 33437
OWNER PROPERTY ADDRESS: 6670 Skunk Lane
Cutchogue, New York 11935
OWNER TELEPHONE NUMBER: 305-737-8286 -
TAX MAP NO. : Section 104 Block 5 Lot 7
CROSS STREET: Haywaters Drive
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Never previously pumped.
Judith T. Terry
Southold Town Clerk
DATE: April 7, 1987
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK
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Town of Southold k ,. C4"- Application No. o�
Judith T. Terry, Town Clerk
` Residential
Town Hall, 53095 Main Road c
P. 0. Box 1179
cnii ; Non-Residential
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Southold, New York 11971 O":®�-���, � `
Telephone :"o.( A��; .��•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
•
Fee $ •
DATE } l
OWNER NAME: VCjs CRLL P- h E. fc
OWNER MAILING ADDRESS: C:i® O CH? ( S d Al 1 1-1E. ll vdvl
3oviv 0tu EmcI-A n-.334317
OWNER PROPERTY ADDRESS: � 6 7 a S' N
OWNER TELEPHONE NUMBER: 051— 7 3_ - pc,
TAX MAP NO. : Section / v 4 Block — Lot
CROSS STREET: HI TER-S '0/&,
04�
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool Existing '
Residential ��N/on-Residential
DATE OF PREVIOUS PUMP-OUT: Y%/
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 of Applicant
RECEIVED BY: c'E .,c
Town lerk's/Office
DATE:
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