HomeMy WebLinkAboutMoore (2) OFFICE OF THE TOWNCLERK • c.OFOU(`,,
Town of Southold
Judith T. Terry, Town Clerk" �z 2�
Town Hall, 53095 Main Road c
P. O. Box 1179LEM-Ly g
Southold, New York 11971 `'� � " '.' �- •�
Telephone Ol
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 514 Residential
Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: Moore/Kelleher
OWNER MAILING ADDRESS: Box 381
Cutchogue, New York 71915
OWNER PROPERTY ADDRESS: New Suffolk Avenue
Cutchogue, New York
OWNER TELEPHONE NUMBER: 516-734-6175
TAX MAP NO. : Section 116 Block s Lot 9
CROSS STREET: Moore's Lane (Linden Avenue)
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X - New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
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Ju id th T. T y _
Southold Town Clerk
DATE: December 3, 1.987
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK c0FO(,t "
Town of Southold ��fes ; CQG 1.1 Application No. L.6-7Y
Judith T. Terry, Town Clerk �►
Town Hall, 53095 Main Road _ ''s ' Residential
P. O. Box 1179 cryt � " �' Non-Residential,
Southold, New York 11971 o���`
Telephone �.( ��
(516) . 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
rur
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE
OWNER NAME: r"lOORg / kelleheR
OWNER MAILING ADDRESS: 'PDX INS5
OWNER PROPERTY ADDRESS: No
cludtoncr,, Ox°L0oil
OWNER TELEPHONE NUMBER: 1j3e1 6/7.5
TAX MAP NO. : Section jl 6 Block 6 Lot ' q
CROSS STREET: mUVI2 L i�1C'
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool V' New Existing i/'
Residential V. Non-Residential
DATE OF PREVIOUS PUMP-OUT: Se?+ 1 87
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.)
171()actz .."'
Signature of Applicant
RECEIVED BY:
�-„w nl e r k' Office
Rreati
DATE:
Town Clerk Southold
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