HomeMy WebLinkAboutScanlon sr , 'A:1-'1I e/�® FO` c
• ®JUDITH T.TERRYft'
Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
% n Southold,New York 11971
REGISTRAR OF VITAL STATISTICS Fax(516) 765-1823
MARRIAGE OFFICER %�'AGEMENT OFFICER ---4 �®����
1Telephone(516) 765-1800
FREEDOM ORECORDS F INFORMATION OFFICER
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3659-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner SCANLON, JOAN E.
Mailing Address 1 P. O. BOX 278
Mailing Address 2
City St Zip ORIENT NY 11957-0000
Property Address 1 34685 MAIN ROAD
Property Address 2
City St Zip ORIENT NY 11957-0000
Owner Telephone No. 516-323-1305
Tax Map No. section 19.00 block 2 lot 5.000
Cross Street •
OLD MAIN ROAD
Issue Date: 7/23/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
OFFICE OF THE TOWN CLERK �FFO
Town of Southold , 0���'' ,:N Application No. 3 63,---Cf"Judith T. Terry, Town Clerk Z "` , %
Town HaII, 53095 Main Road -� $10.00 - Residential
P. O. Box 1179 ':,.7.' , .: .,, °` ►�i $25.00 - Non-Residential
Southold, New York 11971 ® ` ' . ,'�`
Telephone 7®.(7
1 ilft. 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: \‘ O J S Sc,,a/2 :6�
OWNER MAILING ADDRESS: , 130,y 0;7t
(2.-fefl7L Pig /95"
OWNER PROPERTY ADDRESS :
l 17,..3 cr> rl
OWNER TELEPHONE NUMBER: —/4' L_3 1 3 6 L6----
TAX MAP NO. : Section / Block 7 Lot S
CROSS STREET: 0/e/ q i f7 '
TYPE OF SYSTEM: Septic Tank New Existing /
Cesspool . V New Existing 6/
Residential Irir 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.)
4111 7
69:kJ , . /, -
or .r
Signature of pplicant
RECEIVED BY:
Town Clerk's Office
DATE:
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