HomeMy WebLinkAboutGillies A
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® $ Town Hall, 53095 Main Road
P.O. Box 1179
` � �, ,t Southold, New York 11971
JUDITH T.TERRY - _'iik $15^_. � �'1�' FAX(516)765-1823
„,,, TELEPHONE(516)765-1801
TOWN CLERK
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. 1384-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner GILLIES, JOHN E.
Mailing Address 1 320 CONKLIN STREET
Mailing Address 2
City St Zip FARMINGDALE NY 11735-0000
Property Address 1 MAIN ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-249-0040
Tax Map No. section 102.00 block 2 lot 15.000
Cross Street DEPOT LANE
Date Of Last Pump Out 0/00/87
Issue Date: 2/14/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK .c�� (�FFO ,.„•
Town of Southold C'& : Application No. /.3er
Judith T. Terry, Town -Clerk % • 04. 4
�° sr 4 $10.00 - Residential
Town Hall, 53095 Main Road � lir '�N°- .
P. O. Box 1179 ;rt WVi $25.00 - Non-Residential
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Southold, New York 11971 O ` =it''. . .$
Telephone 0 sk� t
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLI C AT ION
for • ,.. _ _ _ _
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
. DATE 0/52
OWNER NAME: acb 4) E--. 6 '//B e s •
OWNER MAILING ADDRESS: 3 200 (_® 4/ telmi S7
Fibe /49 /i'' .Di9 Le
OWNER PROPERTY ADDR_SS • ., 6, e f-=
OWNER TELEPHONE NUMBER: .5.-/e Z(4Q/ - 2Q Kio
TAX MAP NO. : Section /p.Z__ Block Lot O
CROSS STREET: ii.Dijia .� ,
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: ./PX,
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:
Town Clerk's Office
DATE:
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