HomeMy WebLinkAboutMills (2) /
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\ ,, Town Hall, 53095 Main Road
%=t75;.?: '' ' '-'7 '..,,V- P.O. Box 1179
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Southold, New York 11971
JUDITH T.TERRY - g 'I'0�'I 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. 709-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner MILLS, MARY
Mailing Address 1 265 FACTORY AVENUE
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 265 FACTORY AVENUE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-8775
Tax Map No. section 122. 00 block 6 lot 7. 000
Cross Street MAIN ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 5/19/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK FO(,r
Town of Southold )-,06'
�� <»� ,,� CQ� Application No. 2O
Judith T. Terry, Town Clerk ¢ _ -nom .�%' Residential
Town Hall, 53095 Main Road . - 4 -
P. O. Box 1179 . 't * .`r Non-Residential
Southold, New York 11971 0 ,� h •
Telephone .( 0 •.
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 7 0 cf
Fee $ •
DATE 5-17.�
OWNER NAME: iLik-Cfr°41/;k1-•(---e----e--
OWNER MAILING ADDRESS: 6 C 4 ci.„..,00-7„...._,_
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OWNER PROPERTY ADDRESS: - C(_.- a -p-�-`2-.
OWNER TELEPHONE NUMBER: 0 _ f -2 7
TAX MAP NO. : Section h.. Z Block 6 Lot 7
CROSS STREET: ,2P/(.
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool 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.)
. r/7if g fr21-44
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
bl�Y 1 9 -
1988
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