HomeMy WebLinkAboutGillooly 1LaffWas ",
:, `� Town Hall, 53095 Main Road
tr +��`� P.O. Box 1179
� � Southold, New York 11971
JUDITH T.TERRY *,7,0‘. TELEPHONE
row CLERK (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 . 838-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner GILLOOLY, RICHARD JOHN
Mailing Address 1 397 CARRIAGE LANE
Mailing Address 2
City St Zip WYKOFF NJ 07481 -0000
Property Address 1 VILLAGE LANE
Property Address 2
City St Zip ORIENT NY 11957-0000
Owner Telephone No. 516-323-3500
Tax Map No . section 26. 00 block 1 lot 2 . 001
Cross Street WILLOW STREET
Date Of Last Pump Out 7/00/86
Issue Date: 9/15/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
.47
OFFICE OF THE TOWN CLERK
Town of Southold OC�VF V Application No. .c37
Judith T. Terry, Town Clerk
h�• Viz;;_.��.` y.•G 7 Residential
Town Hall, 53095 Main Road o *11
P. O. Box 1179 cn Non-Residential
Southold, New York 11971
Telephone 40/ 0.•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. _
Fee $
DATE
•
OWNER NAME: lIC/171-12b ZOthl (SILLacti, 7
OWNER MAILING ADDRESS: 39' 7 CAP--R4-6.0.- 1- ylf
toy,orf At- 37 a _
OWNER PROPERTY ADDRESS: L1,LLrtz/f ci)/LLocv S/
O/'/mii /if'cj //9C7
OWNER TELEPHONE NUMBER: 676.-32,3-9,0 // O/_cS9// c117`
TAX MAP NO. : Section to Block f Lot 1
CROSS STREET: litaif'tic' top/lad S`
TYPE OF SYSTEM: Septic Tank x New Existing
Cesspool ')( New Existing
Residential l( Non-Residential
DATE OF PREVIOUS PUMP-OUT: \ICJL-y /9c9- 61
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: V
Town ,Clerk's Office
DATE:
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