HomeMy WebLinkAboutMooney tri///,I�iy_yy,
re,44404fic;\\_ Ek A
Town Hall, 53095 Main Road
P.O. Box 1179
-*/ 0, Southold, New York 11971
=> �r.
JUDITH T.TERRY 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. 976-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner MOONEY, PATRICIA ANN
Mailing Address 1 29 SUNSET ROAD
Mailing Address 2
City St Zip BAY SHORE NY 11706-0000
Property Address 1 PRIVATE ROAD OFF MAIN ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 000-665-4399
Tax Map No. section 55.00 block 6 lot 33.002
Cross Street LAUREL LANE
Date Of Last Pump Out 0/00/00
Issue Date: 1/09/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
. ,�,
OFFICE OF THE TOWN CLERK tc�vFFO(,r`;-
Town of Southold N �•• Application No. V7,74
Judith T. Terry, Town Clerk ‘ Z , �,,�,
Town Hall, 53095 Main Road "~� � Y : Residential
p. O. Box 1179 Cr' C , Non-Residential
Southold, New York 11971 '� { � �f
Telephone
(516) 765-1801
l �i TOWN OF SOUTHOLD
RICDEC 01, 19 SOUTHOLD WASTEWATER DISPOSAL DISTRICT
`fan ClatiS® scold APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. g74-
•
Fee $ /0, /9 °
DATE ] - )4- If,
• OWNER NAME: A,4%/� /G'//9 /7200x) ,--=--y
OWNER MAILING ADDRESS: 4f � >e�� �'C=� "d,
/5,57/ ,f/716,e61" LI . ///o
OWNER PROPERTY ADDRESS: / /7
\oU7-i`/OG66 /O}/. //77/
OWNER TELEPHONE NUMBER:
TAX MAP NO. : Section s(-,c, Block Lot ,
CROSS STREET:
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
f` distance, approximately, to building and closest road.)
Signature of Applicant
RECEIVED BY: ( 4070`/
p . Cle " 's e ffice
DATE: t - /
! V
hi
' .,,.`n t.t1 ! JO �+ .�f'9.�0 P iC ' l•'. �' - 31.-.
- -- 'y, .•f�e,,•�(�.�I, f �' Imo// •
`. La ` 'f % 1
\ ! _ do , b ar,..:...—...---7.6---3: °;
• AT _— i
Al7"'"',, .... — 26Z.Ctt+ _5(../F.-FOL-e< ��rxoaazm u +avunw. t
Ca../A1 T s A Y L,s Hats suxvFy t;A vtouT[OFt or t
1 E3CTION 72[Y,J OF T?¢RSV/TOW Sim'
ai, ' _ to [LOOC.A110m LAW.
o1TEs OF MIS SURVEY aur Nov !
-' tx
I Asa ssPcz um yAxLsc' SEAL OR {
i L:..-
. . ,-.4—
.:,
ti' i t10 D:A NAL9 TRICE COPY.NOT fl� roEGt,
z v- .,J K a t;U1 _L 1-55,-, PUARAMTEF-5 atoICAho HER.soas 3iAu. I
• ` • t ci To TH: ps,RSpy FOR WHOM THE se '
i ,j -�' • �_--� !i PtEPAkEA APO ON HIS gEyyf TO TN, i
i%TLF COMPANY,
#`- � i,..---.'
�`AIDUtG GOVERNMENTAL AGENT'
t/ i Com!?� �rrei r ' in �O THE a5'�tTllTiGt/US�► �
._ � lUT10Tol:GUAZgrrrE�, DAPS
m [C1 A^ arl RE AST
Scale: ;D0'�1„ owmots, attlassr.+. t.
U �., ref-,„ A red ._ 2.0 qc-,,e ,_05°1 1
_�
:�1 � , + t ► 5,. .Co.rar Mab 0t?5 r"ro_ s;OK' =Fear; - • _, '
' i � 1 J:''� IOJpc t,par_ '` sas; �'-
c,, .=elac�=��..Ya✓t:.T i:o t,33 i
,,,z+
! 4.
G;C
i'17::, 111 774,le l.lv.7.I- •_-'7-t: 1•�'.- - _ .
•
L. •
.•l..`_✓Gi Ave .'al'Q,YiPPd fp `C _1t
I
i C �` rsG� 'rr'�: : rr.w
i E o. sir✓e•.tc 7 Ju.r. y7
f` -► K y f _
i ii
1 1 t i, i —iGbrlsea -",-1;;;;.;•.•7,-/ r: ,
' 5. �` + '
-
- ^^y3"x'LY "7," �r-,�'~x,,-;-, _ ,, ,.. .,,.„-i„... ,.n,_-"-i'^-t�.^�._-. _�..._ --- - -- --- — _ ___ - j,•