HomeMy WebLinkAboutShanahan OFFICE OF THE 'OWN CLERK c�� f� 1'
Town'sof Southold OQ h Y
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road i-
P. O. Box 1179 con
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Southold, ,New York 11971 ob .‘
Telephone 701
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation. Permit No. 568 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool X
NAME OF OWNER: Michael P. Shanahan
OWNER MAILING ADDRESS: P.O. Box 857
Mattituck. New York 11952
OWNER PROPERTY ADDRESS: Park Avenue
Mattituck, New York
OWNER TELEPHONE NUMBER: 516-298-9158
TAX MAP NO. : Section 123 Block 8 Lot 15
CROSS STREET: Bungalow Lane
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: 8-86
Judith T. Ter
Southold Town Clerk
DATE: January 11, 14488
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK COFOCA,i
Town of Southald Application No.
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road 21k^� - Residential
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P. O. Box 1179 � Non-Residential
Southold, New York 11971 ® ® OP,�
Telephone ( ��
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.„5317.
Fee $ /O.
DATE ,/A0-7
OWNER NAME: /Ma/06 P `sA 'N4/M/I/
OWNER MAILING ADDRESS: % a0)C CSS 7
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OWNER PROPERTY ADDRESS : U I� � - Avg--
OWNER TELEPHONE NUMBER: (9-V-- 9 IS
TAX MAP NO. : Section 12 3 Block Lot kr
CROSS STREET: ad...5( (.._OtAl .
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential /NC Non-Residential
DATE OF PREVIOUS PUMP-OUT: By/P-0
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.)
ignature of Applicant
RECEIVED BY: • ckat._`. 0 _
me TOWn Cler,"s Offic-
DAT E: JAN 1117
SnNar, mark Southold
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CERTIFIED TO:
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. CHICAGO TITLE INSURANCE CO
FOR- MICHAEL SHANAHA N
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tICAL3 INSURANCE CUwF� Fo '-- `5.'- . ` riverhead new york 11901
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(516) 727.4455 �*.. LAND s
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tar # 6') / — b 3 5 I� 6 Job N° 86-1236
April 21, 198
r. ,c). 1571 Acres,•' 1000- 123-08-15 Scale: l"=20'
AREA. 6,843 SQ F
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