HomeMy WebLinkAboutShanahan (2) OFFICE OF THE TOWN CLERK'-- I c3\FFO(i`r�
Town of Southold
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road _-
P. O. Box 1179
Southold, New York 11971
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 225 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool x
NAME OF OWNER: William J. Shanahan
OWNER MAILING ADDRESS: Locust Lane
Southold, New York 11971
OWNER PROPERTY ADDRESS: Locust Lane
Southold, New York
OWNER TELEPHONE NUMBER: 516-765-2840
TAX MAP NO. : Section 62 Block 3 Lot 26
CROSS STREET: Korn Road
TYPE OF SYSTEM: Septic Tank New _ Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
Judith T. Terry
Southold Town Clerk
DATE: February 17, 1987
(TOWN SEAL)
b II ra,
OFFICE OF THE TOWN CLERK �FF� -.
'1
Town of Southold �� CD . Application No. "
Judith T. Terry, Town Clerk i►
Town Hall, 53095 Main Road � ; -4 ` Residential ✓
P. O. Box 1179 u-3 t � ' . Non-Residential
Southold, New York 1197145/
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Telephone `
(516) 765-1801
( r.C,EVVED TOWN OF SOUTHOLD
:; f3 01987 SOUTHOLD WASTEWATER DISPOSAL DISTRICT
Town Cork Southold
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ I0 '. as
DATE Y 3 '/ 1 ' s 7
OWNER NAME: Li 2 /1. c ti T• S � � -, `
OWNER MAILING ADDRESS: L. . < ks •�- L�
So � f � oIr.0 / N-y ray 7i
OWNER PROPERTY ADDRESS: 5 1. S.
OWNER TELEPHONE NUMBER: s- - 7 G S - z sr y c)
TAX MAP NO. : Section 6 Z Block 3 Lot Z 6
CROSS STREET: Lo < " st LSHe_ 4
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ✓ New Existing ✓
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: d--
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 of Applicant
RECEIVED BY:
RECIENTE�wn rk's Of ce
DATE: .1 B:�u®r'rr n^y
FED L?
Town Clark Southold