HomeMy WebLinkAboutGarvey OFFICE OF THE TOWN CLERK ., ,,��cstIFOCkc"
Town of Southold � OG -
Judith T. Terry, Town Clerk � .�
Town Hall, 53095 Main Road
P. O. Box 1179 cn
Southold, New York 11971 Q • .4_
Telephone
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(516) 765-1801 '
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
'SEPTIC TANK or CESSPOOL
Operation Permit No. 196 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool x
NAME OF OWNER: Bernadette M. Garvey
OWNER MAILING ADDRESS: Box 253, Peconic Bay Blvd. , Mattituck, NY 11952
67 Hilton Avenue, Garden aty, NY 11530
OWNER PROPERTY ADDRESS: 6325 Peconic Bay Blvd.
•Laurel, New York
OWNER TELEPHONE NUMBER: 516-298-4289 741-241-0460
TAX MAP NO. : Section 126 Block 10 Lot 23.1
CROSS STREET: Bray Avenue
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: None
ma '
Juh T. Terr
Southold Town C erk
DATE: January 8. 1987
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK g utFu /Q,
Town of Southold ��� e ,- Application No./ /
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Judith T. Terry, Town Clerk ZtL '"4__z
� �= � ) Residential
Town Hall, 53095 Main Road caw
P. O. Box 1179cn :' Non-Residential
Southold, New York 11971 %® ® _ y�e
Telephone 0.� Ng;
aso(N6 765-1301
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WO TOWN OF SOUTHOLD
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down Clergy $ental SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for.
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ I 6 0\-1.1
DATE I / q."4
• OWNER NAME: sQ_r_2,.. /
B 01C 2 5� (P 'i' /4-(/717) s 67y-e_
OWNER MAILING ADDRESS: ,--T`¢' ide_ic....,
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OWNER PROPERTY ADDRESS: f)
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63 ALI
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OWNER TELEPHONE NUMBER: - Z FCaz-°F (-0- 't•4 o )
TAX MAP NO. : Section 42_,lv Block lo Lot 6123r/
CROSS STREET:
TYPE 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 buildiFnng�and_closest road.)4it" /16,14,a1 2) ae...43--yie-le- /30-1 -
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Signature of Applicant
ciAA-14
RECEIVED BY: c tMEWED
Town/Clerks ffice
DATE: fl A
987
Town Clerk Southold
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