HomeMy WebLinkAboutGormley 1424 440
Town Hall, 53095 Main Road
..�' P.O. Box 1179
� .
;� !� Southold, New York 11971
JUDITH T.TERRY -® ll
TELEPHONE
TOWN CLERK (51 6) 765-1801
REGISTRAR OP VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 922-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner GORMLEY, JOHN P.
Mailing Address 1 440 SUNSET WAY
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 440 SUNSET WAY
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-1929
Tax Map No. section 91 .00 block 1 lot 8.000
Cross Street CEDAR BEACH ROAD
Date Of Last Pump Out 0/00/86
Issue Date: 11/17/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
• III iii
OFFICE OF THE TOWN CLERK ���FFO(�.��= �
Town of Southold �� r . ..(/ , Application No. -'.a. --
Judith
Judith T. Terry, Town Clerk �� ' ,-Y.,1, ',.-.-
.�, ,
Town Hall, 53095 Main Road q" t .- ` Residential
C=3 0! 'Ptd u?
P. O. Box 1179 cry %'"` ,;t�} =' i �`' Non-Residential
Southold, New York 11971 O ®, ,_%`• ��`�
Telephone _ 1
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
\
Operation Permit No.
Fee $ /0
DATE I I ' 1 -1 " SS
OWNER NAME: 1 rU 1-1 �, k fi ' 1 L ,.....7
OWNER MAILING ADDRESS: L1,I4.O S UOISET WC Ay
Sou f¢ oL. P r /y. rrct `] l
OWNER PROPERTY ADDRESS: S A "1 E.
OWNER TELEPHONE NUMBER: -1 Co $' - l 1 1,1
, r1q7 aEyAk eP)E14} PA OK qv .8/1r vt/5- w
TAX MAP NO. : Section 9/ Block 1 Lot
CROSS STREET: C_L-,DR R 1-6 CRc (-( RP
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool 'IN. New Existing X.
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: ( CI 3t, _-
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.)
. 6—PAAA C li CL1A176.
Signature of Applicant
RECEIVED BY: , 5-14-°"---`
own Clerk's Office
DATE: ////7 (Fr
Keg*
'Novi 1988
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