HomeMy WebLinkAboutMealy EIL
Town Hall, 53095 Main Road
tZF
;!�`, P.O. Box 1179
_ ®� �`� I Southold, New York 11971
JUDITH T.TERRY "di 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. 979-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner MEALY, OTHA AND WIFE
Mailing Address 1 P. O. BOX 469
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 2360 GRAND AVENUE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-8442
Tax Map No. section 107.00 block 2 lot 9.001
Cross Street WOODCLIFF DRIVE
Date Of Last Pump Out 0/00/00
Issue Date: 1/09/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
SI
OFFICE OF THE TOWN CLERK 0c�vFFO(,'�'=
Town of Southold �� �QG' Application No.g7?
Judith T. Terry, Town Clerk .
Town Hall, 53095 Main Road Residential
P. O. Box 1179 tramoi '' Non-Residential
Southold, New York 11971 Obi ` *-STelephone - :rnl_. y►�• -
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 959°
Fee $ / r
DATE I—
OWNER NAME: 1\ a h714: ! 1A, -4r laric
OWNER MAILING ADDRESS: (g . ci �v ( 9 / f
, 6 3 1R I"' 6(�.
I' abb
OWNER PROPERTY ADDRESS: _ "3 .(4,
�.: c ,i.
OWNER TELEPHONE NUMBER: 6162 -W 4/j
TAX MAP NO. : Section / 0 7 Block Lot c /
CROSS STREET: 91100 17 C
TYPE OF SYSTEM: Septic Tank O VNew Existing r,/.
Cesspool \ V/* New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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 Applic nt
RECEIVED BY:
Town Clerk's Office -
DATE:
` V
b
.71
G
W
Q
V06
6 d r