HomeMy WebLinkAboutShalvey (2) P1 ip
r ,, Town Hall, 53095 Main Road
. N-Sy e.Zr P.O. Box 1179
=_�®� .• Southold, New York 11971
JUDITH T.TERRY FAX(516)765-1823
TOWN CLERK TELEPHONE(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. 1517-R Residential X Non-Residential
Fee $ 10.00 Septic- Cesspool X
New Existing X
Name Of Owner SHALVEY, THOMAS JR. & BARBARA
Mailing Address 1 P. O. BOX 911
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 MAIN ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11193-0000
Owner Telephone No. 516-734-5619
Tax Map No. section 109.00 block 3 lot 2.004
Cross Street LINDEN AVENUE
Date Of Last Pump Out 0/00/85
Issue Date: 8/10/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
III
•
OFFICE OF THE TOWN CLERK ' �FFour
Town of Southold .&% CG- Application No. 577
Sdf Y q D/
Judith T. Terry, Town Clerk �'f , $10.00 - Residential
Town Hall, 53095 Main Road1G ,�
p. 0. Box 1179 ¢ u '" i ��
$25.00 - Non-Residential
Southold, New York 11971 nio'iii1;;„.L.*);\;:c.70
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /0 .oa
DATEAU9 7 1990
'OWNER NAME: � T� ,ha ,,4 SAaJve/
OWNER MAILING ADDRESS: 4/) ?//
t 7 A c11 e_ ,Uei,) int-1- //9.3a-
OWNER PROPERTY ADDRESS: Mr lin in ,,r'r/
etcln.An 4 �)ei Q . Yo. r k I/f6:35—
OWNER
5OWNER TELEPHONE NUMBER: 5/6, —
TAX MAP NO. : Section Block Lot
moor es Lar,e,
CROSS STREET: 4./vaJ!s ),c&ne., (i000 w /.ii' h-oore� L )
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool g New Existing A
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: /9rg'
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.)
A A,
'Signatur of Applicant
RECEIVED BY:
Ts Office
DATE: AUG 10 199U
tow Clerk
1
1
Ay
Cr( I cp,
P i
1
0 r)
u-, ______)0
1
i
1
R
1
S
i•