HomeMy WebLinkAboutGrattan (3) ersof Duce'iv
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i Town Hall, 53095 Main Road
Ii � P.O. Box 1179
0; Southold, New York 11971
JUDITH T.TERRY �. TELEPHONE
TOWN 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. 3669-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner GRATTAN THOMAS SR.
Mailing Address 1 41900 MAIN ROAD
Mailing Address 2
City St Zip PECONIC NY 11958-0000
Property Address 1 41900 MAIN ROAD
Property Address 2
City St Zip PECONIC NY 11958-0000
Owner Telephone No. 516-765-5698
Tax Map No. section 86.00 block 1 lot 8.000
Cross Street PECONIC LANE
Issue Date: 8/04/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE •
OF/THE TOWN CLERK ,COW `'• 3 “
Town of Southold +j14
Application No.�
Judith T. Terry, Town Clerk .� ' '
Town Hall, 53095 Main Road n z°� 4; :� $10.00 - Residential
P. O. Box 1179 c '4941.040 :' $25.00 - Non-Residential
Southold, New York 11971 O
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
•
Operation Permit No.
Fee $ AV:1,5,c
DATE
OWNER NAME:_ /Y) S 0/e 779 J
OWNER MAILING ADDRESS: 1/7V /4/1M/ , O./TD
ttc01G ey /„4712
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: 7‘‘-r:1`-rr rff
TAX MAP NO. : Section ?(c' Block ( Lot
CROSS STREET: �conl/ t. Z AJE
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool_ V New Existing
Residential t/ Non-Residential
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.)
/ 1
/74' ,AeLL °
S'gnature of pplicant
RECEIVED BY:
Town Clerk's Office
DATE:
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