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'� Town Hall, 53095 Main Road
, or P.O. Box 1179
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... 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. 1230-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner GALLIGAN, JOANNE M.
Mailing Address 1 2185 WEST VIEW DRIVE
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 2185 WEST VIEW DRIVE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-5112
Tax Map No. section 107.00 block 7 lot 1 .002
Cross Street WOODCLIFF DRIVE
Date Of Last Pump Out 0/00/80
Issue Date: 8/25/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK �c,VFFiAji,- -
Town of Southold 4(.41".4:
�1 � Application No. /2 3O
Judith T. Terr Town Clerk �y� �c1I 10.00 - Residential
Town Hall, 53095 Main Road $
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P. O. Box 1179 cn ;L �
°P. �. �=�� �� $25.00 - Non-Residential
Southold, New York 11971 ' = . ��
Telephone -.../6:11%
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE sSI, ( -
'OWNER NAME: 1. 't K • �-7 ALL\ C-r4:k1•1 •
OWNER MAILING ADDRESS: (q.13,5 kx)E,S U ('GW .b9 fe
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OWNER PROPERTY ADDRESS: S Ph1v
OWNER TELEPHONE NUMBER: SIC-- 9.,Ca' ,j l 1
TAX MAP NO. : Section I bM- m /, Block -r Lot ...
CROSS STREET: t�1/4.) cL t fl 9 (2-A VC-.
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: 1R
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.)
0--tia-42-- -.-- 0 k \ : -
Signatu of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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Town Hall, 53095 Main Road
j O v P.O. Box 1179
c® Southold, New York 11971
765-1823
JUDITH T.TERRY >��.��i�'��� O. Box 11(16)765-1801
TOWN CLERK
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
August 7, 1989
107-7-1 .2 7-89 -
Charles Galligan
2185 West View Drive
Mattituck, New York 11052
Our records indicate that you recently had your cesspool/septic tank system
pumped out. According to the Southold Town Scavenger Wastes Ordinance, any
owner of an operating, on-site sewage disposal system, such as a septic tank
or cesspool, must obtain an Operation Permit for that system.
The Operation Permit is issued by the Southold Town Clerk's Office. The
fee is ten dollars ($10.00) for a residential system, twenty-five dollars ($25.00)
for a non-residential system. You will not be asked to obtain an Operation Permit
each time you have work done on the system, the permit is only issued once
for each system.
Enclosed is an application for an Operation Permit. Please complete the
application and return it to this office along with the location map and proper
fee. (NOTE: The location map may be a copy Of your survey with the location
of the cesspool(s) indicated or a sketch of your property showing the location
of the buildings, cesspool system, and approximate distance in feet to buildings
and closest road.) Also included is an Informational Bulletin regarding the
Southold Town Scavenger Waste Treatment Facility. I hope this will aid you in
understanding the Scavenger Wastes Ordinance.
Please do not ignore this request. Should you have any questions or need
any assistance with the application, please do not hesitate to contact this office.
We will be happy to assist you in any way we possibly can.
Very truly yours,
67‘edz.A.",
Judith T. Terry
Southold Town Clerk
Enclosures (2)