HomeMy WebLinkAboutGannon JUDITH T. TERRY /4#
.. Town Hall, 53095 Main Road
TOWN CLERK z T P.O. Box 1 179
REGISTRAR OF VITAL STATISTICS tri �� Southold, New York 11971
MARRIAGE OFFICER yQ O� �, Fax (516) 765-1823
NO' "w sTelephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3107-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner GANNON, DOROTHY
Mailing Address 1 P. O. BOX 1625
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 MCDONALD'S CROSSING
Property Address 2
City St Zip LAUREL NY 11948-0000
Owner Telephone No. 516-298-8721
Tax Map No. section 145.00 block 4 lot 18.000
Cross Street YOUNG'S DRIVE
Date Of Last Pump Out 0/00/00
Issue Date: 8/26/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
�• S „,.
OFFICE OF THE TOWN CLERK c3IFD(,i-
Town of Southold % CQ Application No.' /O I
Judith T. Terry, Town Clerk . F-' i• :,1
Town Hall, 53095 Main Road �'"` $10.00 - Residential c/
P. O. Box 1179 a ,v' =-s ? : %
$25.00 - Non-Residential
Southold, New York 11971 'Si t® t ��`
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Telephone N'llgtH‘Ne .1
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
l Fee $ •
8
DATE 46 4 3
•
OWNER NAME: -11
Cb Teen04 \ g7/) 476 ill
OWNER MAILING ADDRESS: n C). �. / 6_02,6---
KA (9__>
o_02,(KA (9__ - I ic_g. , 1Uv V //I2 sem.
OWNER PROPERTY ADDRESS: k C )O AA-4_0 1 ',6 ,c'_svy[p
1,fis-Lir- . id f q,
OWNER TELEPHONE NUMBER: ,2,9 ,. - r / � / ,
,
TAX MAP NO. : Section it qr Block d Lot a e
CROSS STREET: ycu / rC D ,_,,,,----
•
TYP E OF ,SYSTEM:" Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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.)
lam'`
SignatureApplicant
RECEIVED BY: (1)./Co
Tow Clerk's Office
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DATE: ( 73
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