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JUDITH T. TERRY ; Town Hall, 53095 Main Road
TOWN CLERK t rrt P.O. Box 1179
REGISTRAR OF VITAL STATISTICS s, �� Southold, New York 11971
�®
MARRIAGE OFFICER ®�' , Fax (516) 765-1823
41 Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 2075-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner SPILLANE, IRENE O.
Mailing Address 1 BOX 393 -
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 985 WEST CREEK AVENUE
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-5978
Tax Map No. section 103.00 block 13 lot 12.000
Cross Street NORTH CROSS ROAD
Date Of Last Pump Out 0/00/85
Issue Date: 3/10/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK p P.O. Box 1 179
REGISTRAR OF VITAL STATISTICS � Southold, New York 11971
MARRIAGE OFFICER � ®�' �, Fax (516) 765-1823
W.
, / Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 2075-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner SPILLANE, IRENE O.
Mailing Address 1 BOX 393 -
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 985 WEST CREEK AVENUE
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-7311-5978
Tax Map No. section 103.00 block 13 lot 12.000
Cross Street NORTH CROSS ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 3/10/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK cvFFUCA'�'-
Town of Southold �� : tt, CQG', Application No. 0207
Judith T. Terry, Town Clerk . �
Town Hall, 53095 Main Road 7 $10.00 - Residential
P. O. Box 1179 crs "'- ? ; $25.00 - Non-Residential
Southold, New York 11971 0p�,
Telephone j
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
, DATE -3/6/�
OWNER NAME: E 6, S p//h/2-(17/-
OWNER MAILING ADDRESS: 7F,S -(ir�� t-& 1., 39'3
OWNER PROPERTY ADDRESS: �_.
OWNER TELEPHONE NUMBER: 1 - SCJ 7f
TAX MAP NO. : Section / b Block / Lot / (9\,
CROSS STREET: d
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool )(
New Existing
Residential "1 Non-Residential
DATE OF PREVIOUS PUMP-OUT: O-//,S/ .�
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.)
6_,Liz,z,
Signa ure of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
dit
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