HomeMy WebLinkAboutGuinan Town Hall, 53095 Main Road
���" P.O. Box 1179
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JUDITH T.TERRY �� ./,/°��,I 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. 640-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner GUINAN, PATRICIA
Mailing Address 1 BOX 251
Mailing Address 2
City St Zip PECONIC NY 11958-0000
Property Address 1 INDIAN NECK LANE
Property Address 2
City St Zip PECONIC NY 11958-0000
Owner Telephone No. 516-734-6545
Tax Map No. section 86. 00 block 7, lot 5.000
Cross Street ROBINSON LANE
Date Of Last Pump Out 0/00/00
Issue Date: 3/07/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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� CQG' , Application No. ��
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NOP Residential
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LD WASTEWATER DISPOSAL DISTRICT \(1 Y7;�1
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APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /
DATE 3 / r ff__
OWNER NAME: GA 1 i 1 C /f 0- I 4
OWNER MAILING ADDRESS: ( .--(%/(, -
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OWNER PROPERTY ADDRESS: ii1r0),P) Li( I� d16-
OWNER TELEPHONE NUMBER: ---73(-4 6,5-145
TAX MAP NO. : Section (f1-6 Block 7 Lot
CROSS STREET: 11-,„K°4
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool V New Existing
Residential V Non-Residential
DATE OF PREVIOUS PUMP-OUT: -40j-
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 .. Applicant
RECEIVED BY: _
Town Clerk's Office
DATE: -