HomeMy WebLinkAboutMeehan 1/1����/�/_/ISI,_:► .��'._
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,„17 trini Town Hall, 53095 Main Road
H O � P.O. Box 1179
fe, 1,4" Southold, New York 11971
JUDITH T.TERRY ;,�i�l� 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. 1367-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner MEEHAN, ELEANOR
Mailing Address 1 MASTERSON, HANNAH
Mailing Address 2 BOX 1025
City St Zip MATTITUCK NY 11952-0000
Property Address 1 1475 WESTPHALIA ROAD
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-9433
Tax Map No. section 141 .00 block 1 lot 8.000
Cross Street HORTON AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 1/11/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
` . .e
OFFICE OF THE TOWN CLERK c�VFFO(,T �
Town of Southold ; Application No. /3‘ 2
Judith T. Terry, Town Clerk . ,r ' ;;+ _ y —
Town Hall, 53095 Main Road -� �,j=, $10.00 Residential
P. 0. Box 1179 cr3 ti r i
$25.00 - Non-Residential
Southold, New York 11971 O ®
Telephone 0
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE /'3-90
OWNER NAME: L/c/U/O kEE/1///1/ Anr,UE ��ST/lsav
OWNER MAILING ADDRESS: 130 Z„r'
/4i4 7-7- /7 cf", /1/ ys 11y S 2—
OWNER
OWNERPROPERTY ADDRESS: /4/76- 02,J Z/041 �GR�
MR7-7- /T A c,`: / 42. 7. /7s-2-
OWNER
OWNER TELEPHONE NUMBER: 7e. 99.E
TAX MAP NO. : Section A /41/ Block NO- / Lot
CROSS STREET: Ho/Z 7D /1> 191Eka
TYPE OF SYSTEM: Septic Tank - New Existing
Cesspools New Existing V
/
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 Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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