HomeMy WebLinkAboutSt Patricks 5 . i
, Town Hall, 53095 Main Road
"O P.O. Box 1179
PO * Southold, New York 11971
JUDITH T. TERRY 4r�I'AV'''°1A/$
TELEPHONE
TOWN CLERK (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. 1069-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner ST. PATRICKS CHURCH RECTORY
Mailing Address 1 MAIN ROAD
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 MAIN ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-3442
Tax Map No. section 63.00 block 5 lot 10.002
Cross Street TUCKERS LANE
Date Of Last Pump Out 0/00/86
Issue Date: 4/04/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK 9SVFFN,('.„-
Town of Southold Application No. /0
Judith T. Terry, Town Clerk ‘ ia,
Town Hall 53095 Main Road E4V Residential
p, O. Box 1179 cn ;- Non-Residential
Southold, New York 11971 O ®v Telephone.( * /4-01
•,.
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE fifil"
OWNER NAME: T.0IC TG /C1/1— C/a/
OWNER MAILING ADDRESS: ed,/ / .
Ute;, t% /Vy 1/77/
OWNER PROPERTY ADDRESS: <4141
OWNER TELEPHONE NUMBER:
TAX MAP NO. : Section Ca 3 Block Lot /O .o7
CROSS STREET: /00,0 49 1/6-t /7 //ht/
Akeri/ 7;446/61
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: /fid
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.)
4. 0-0a-Vido, 47,„Signof Applict
RECEIVED BY: LA-/
75own Clerk's Office
DATE:
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