HomeMy WebLinkAboutShahan if/1 -0
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._ate . Town Hall, 53095 Main Road
r �`� P.O. Box 1179
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JUDITH T.TERRY - ®j in i!
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OFFICE OF THE TOWN CLERK rj�FF ' -
Town of Southold Q C'�% Application ,No. 2.70i
.Judith T. Terry, Town Clerk f'r ".4y
Town Hall, 53095 Main Road It Residential
P`: O. Box 1179 (r) 744 Z` Non-Residential
Southold,- New York 11971 ozi
Telephone - 1,1 j
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(516) 765-1801 :;57
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE July 20, 1988 -
OWNER NAME: Gladys M. Shahan
OWNER MAILING ADDRESS: P.O. Box 1076
Southold, NY 11971
OWNER PROPERTY ADDRESS: 300 Hippodrome Drive •
Southold', NY 11971
OWNER TELEPHONE NUMBER: 765-3745 ,„
TAX MAP NO. : Section __1_446 Block--
Lot to--
CROSS
--CROSS STREET: Rogers Road -
TYPE OF SYSTEM: Septic Tank X New Existing X
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: { June 6, 1988
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 cl sest road.)
rll rv. d et f-(-e
Sig ature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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