HomeMy WebLinkAboutPurcell f # Town Hall, 53095 Main Road
" • 'v• 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. 1019-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner PURCELL, KEITH
Mailing Address 1 P.O. BOX 328
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 50900 MAIN ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-1330
Tax Map No. section 70.00 block 2 lot 10.000
Cross Street JOCKEY CREEK DRIVE
Date Of Last Pump Out 0/00/00
Issue Date: 2/14/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
• ••„
OFFICE OF THE TOWN CLERK .r\\FFG ' ''• c./
Town of Southold �' &. Application No. /0 0 /
Judith T. Terry, Town Clerk
= r., ••. .�, - 1 z Residential XXXXXXX
Town Hall, 53095 Main Road a a'xi .
P. O. Box 1179 cn �st� z Non-Residential
Southold, New York 11971 O ® S;.r se
Telephone j
•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT •
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ 10. 00
DATE February 10, 1989
OWNER NAME: Keith Purcell
OWNER MAILING ADDRESS: P.O. Box 328
Southold, New York 11971
OWNER PROPERTY ADDRESS: 50900 Main Road
Southold, New York 11971
OWNER TELEPHONE NUMBER: 516-765-1330
TAX MAP NO. : Section 70. Block 2 Lot 10
CROSS STREET: Jockey Creek Drive
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing XXXXXXX
Residential XXXX)X Non-Residential
DATE OF PREVIOUS PUMP-OUT: January 3, 1989
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:
Town Clerk's Office
DATE:
4
Main Road
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Southold School District