HomeMy WebLinkAboutMoylan OFFICE OF THE TOWN CLERK 6 °C.g OUI#`,�G
Town of Southold Q *rs F y
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road ,
P. O. Box 1179 a �s �:
Southold, New York 11971 � Q % •1 —
Telephone •
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 233 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool X
NAME OF OWNER: John J. and Margaret J. Moylan
OWNER MAILING ADDRESS: 29 McKay Road
• - Huntington Station, New York 11746
OWNER PROPERTY ADDRESS: Arrowhead Lane
Peconic, New York
OWNER TELEPHONE NUMBER: 516-271-3209
" TAX MAP NO. :- Section 98 Block "2 Lot 5 and 6
CROSS STREET: Indian Neck Lane
TYPE OF SYSTEM: Septic Tank X New X Existing
Cesspool X New X Existing
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: New System (See construction permit
No. 91 )
Judith T. Terry
Southold Town Clerk
DATE: March 9, 1987
(TOWN SEAL)
9/
OFFICE OF THE TOWN CLERK cidFO(� =
Town of Southold �� CQ
• G Application No. 02'33Judith T. Terry, Town Clerk .` : . •,* YDS y
Town Hall, 53095 Main Road Residential
P. O. Box 1179 r.<_ - �' Non-Residential
Southold, New York 11971 OO
Telephone : .( * r�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
• APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. �, 3
Fee $ JO
•
DATE 4024,6I G, /987
OWNER NAME: JoA/i✓ -/_ ,gi1D AP/-.e04/2e7. ‘/. AVOY6an/
OWNER MAILING ADDRESS: 29/196#4Y
ED
• //aA/77A/Fi7D/✓ 6r.a. Al.y /1746
OWNER PROPERTY ADDRESS: ,g.ee0044re10 LA -
nEccvN/c ,vew
OWNER TELEPHONE NUMBER: 27/•. 209
a
TAX MAP NO. : Section .98 Block Z Lot 6-' ' 6
CROSS STREET: /A/o%oma/ AJ -C/<'
TYPE OF SYSTEM: Septic Tank New r/ Existing
Cesspool New V 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.)
•
Signature of Applicant
RECEIVED BY: (, c, -
Town Jerk's ffice
DATE: `f)') /ff7
SUFFOLK CO. HEALTH Et•` ='- ' : •� >;
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THE WATER SUPPLY AND SEWAGE DISNzm ._�<
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