HomeMy WebLinkAboutMooney (2) ,, __---
ELIZABETH A.NEVILLEr .� Town Hall, 53095 Main Road
�� '' -NI,.g
TOWN CLERK }
P.O. Box 1179
• OD 4 Southold, New York 11971
REGISTRAR OF VITAL STATISTICS . '.7 I Fax (516) 765-1823
MARRIAGE OFFICER : ® `'
RECORDS MANAGEMENT OFFICER04, ®�1 Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER ®.(
• , •011°
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3827-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner MOOONEY, MAUREEN M.
Mailing Address 1 P. O. BOX 702
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 11520, 11680 & 11700 MAIN RD.
Property Address 2 (ONE SYSTEM)
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-1100
Tax Map No. section 122.00 block 3 lot 3.000
Cross Street PACIFIC STREET
Issue Date: 10/22/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK CS Fair
TOWN OF SOUTHOLD 0� COApplication No. 38. y
ELIZABETH A.NEVILLE,TOWN CLERK ' - *3 $10.00 - Residential
P.O.BOX 1179 g
Lr3SOUTHOLD,NEW YORK 11971 ,` �� $25.00 - Non-Residential
• Telephone _®144 "(
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. f S ' 2
Fee $ •
I
DATE 119 ! l fq
OWNER NAME: M4' /4I' t4' 0/b
OWNER MAILING ADDRESS: P- D a t - 7
M &2 . a/13 f /19'<c)-
I(((aa
OWNER PROPERTY ADDRESS: 7(S--(9-0 / [60-pee "_t`� 0-0 ,/it,g
OWNER TELEPHONE NUMBER: „CIL 2c1't- -ff OP
TAX MAP NO. : Section 1 - -- Block 3 Lot 3
CROSS STREET: P -Ut
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing A- LTr-(1- c)
Residential K. Non-Residential
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 Applican
RECEIVED BY:
Town Clerk's Office
DATE:
•