HomeMy WebLinkAboutGleeson JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK ® az
1a P O. Box 1179
REGISTRAR OF VITAL STATISTICS
Southold, New York 11971
MARRIAGE OFFICER � �*�`' Fax (516) 765-1823
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®�® ��!� Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1940-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner GLEESON, MARGARET A.
Mailing Address 1 1785 CUSTER AVENUE
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 1785 CUSTER AVENUE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-3410
Tax Map No. section 70.00 block 9 lot 11 .000
Cross Street OAKLAWN AVENUE EXTENSION
Date Of Last Pump Out 0/00/83
Issue Date: 6/30/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK •0FD _
Town of Southold �� .. CQG Application No./?V°
Judith T. Terry, Town Clerk .%A);r 1, *A
Town Hall, 53095 Main Road � - $10.00 - Residential
P. O. Box 1179 cry $25.00 - Non-Residentiel
Southold, New York 11971 O10/, �O;er/
Telephone =
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
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OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE
OWNER NAME: /ig- /> ( � � !> Es,
OWNER MAILING ADDRESS: 7 V.:5- CUs
s 6 O /17 7/ // 7 / -
OWNER PROPERTY ADDRESS: /7r�
ds� T -D /V 7/ /7p7
OWNER TELEPHONE NUMBER: ,47/ d
TAX MAP NO. : Section 7 ) Block 9 Lot i
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 building and closest road.)
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Si" ature of . pplicant
RECEIVED BY:
Town Clerk's Office
DATE:
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