HomeMy WebLinkAboutReilly (2)Town Hall, 53095 Main Road,
�® ®� 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. 1308-R Residential X Non -Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner REILLY, RICHARD B.
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Mailing Address 1 P. O. BOX 1072
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Mailing Address 2
City St Zip
Property Address 1
Property Address 2
City St Zip
Owner Telephone No.
Tax Map No. section
Cross Street
Date Of Last Pump Out
Issue Date: 11/15/89
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CUTCHOGUE NY 11935-0000
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NEW SUFFOLK AVENUE
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CUTCHOGUE NY 11935-0000
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516-734-5235
116.00 block 2 lot 13.000
BAY ROAD
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0/00/85
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Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OF,FICE'OF THE TOWN CLERK
.,Town of Southold
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road
P. 0. Box 1179
Southold, New York 11971
Telephone
(516) 765-1801
1 1~
TOWN OF SOUTHOLD
J3
Application No.
$10.00 - Residential—
$25.00 - Non -Residential
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Pet No.
Fee $ % rj
OWNER NAME: "/r/G///q/.?j
DATE
/TI L
OWNER MAILING ADDRESS: 0 9(0x /O 7,;,�
OWNER PROPERTY ADDRESS: /yriv sfjq- ®.t� l/- A rj d4 ��
OWNER TELEPHONE NUMBER: Lr/ � 71? (QO2 V-�,j---
TAX MAP NO.: Section J/ Block 02— Lot
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non -Residential
DATE OF PREVIOUS PUMP -OUT: L5-y-e%S -�— ez
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 Applican
RECEIVED BY:
wo ®Town Clerk's Office
DATE: NOY 15 199
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