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HomeMy WebLinkAboutMooney 1 '4 / %\VOLK i� '' Gym► JUDITH T. TERRY Town Hall, 53095 Main Road TOWN CLERK ® r�r _ P.O. Box 1179 U' Southold, New York 11971 REGISTRAR OF VITAL STATISTICS = �Y ��� Fax (516) 765-1823 ® MARRIAGE OFFICER —40'' •�® 1 Telephone (516) 765-1801 RECORDS MANAGEMENT OFFICER 1 FREEDOM OF INFORMATION OFFICER ': ,�l OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 3219-R Residential X Non-Residential Fee $ 10.00 New Existing X Name Of Owner MOONEY, CARLINE P. Mailing Address 1 45605 MAIN ROAD Mailing Address 2 City St Zip SOUTHOLD NY 11971-0000 Property Address 1 45605 MAIN ROAD Property Address 2 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 516-765-2032 Tax Map No. section 75.00 block 2 lot 13.000 Cross Street - SOUTH HARBOR ROAD 41K- Issue Date: 6/29/94 Judith T. Terry Southold Town Clerk (TOWN SEAL) (d-72)/Y f N ✓ `��, `� �y' ice. IOFVICE OF THE`'TOWN CLERK /�OMir -�- Town of Southold � C�G� Application No. Judith T. Terry, Town Clerk .` }' , � 41r- Town rTown Hall, 53095 Main Road $10.00 - Residential P. 0. Box 1179 tri ;= ;;;',411- �` $25.00 - Non-Residential Southold, New York 11971 Telephone = 1 Y► (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL • Operation Permit No. j -19 Fee $ DATE o17 ) 77 OWNER NAME: 6,440 P. 44 a a Ark-/ OWNER MAILING ADDRESS: '4/ s ( " Sly ri-lv� /itt", - • OWNER PROPERTY ADDRESS: 7Co 0 j /74e -vYV 0 ,) -7-74-01--) /'V /' ,, OWNER TELEPHONE NUMBER: 76 s - ' -13 TAX MAP NO. : Section Block "C17! � /' Lot - J CROSS STREET: AILS S,.4.4„beS ? TYPE OF SYSTEM: Septic Tank New Existing Cesspool a( New Existing Residential .( Non-Residential LOCATION MAP: Must be attached hereto before permit may be issued. 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