HomeMy WebLinkAboutMullen OFFICE OF THE TOWN CLERKFU
Town of Southold
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Judith T. Terry, Town Clerk . ,tt 1,4 X
Town Hall, 53095 Main Road o ux
P. 0. Box 1179 � cn y R
Southold, New York 11971 \ p ®$ Og��
Telephone ' �1 NN�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 511 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool X
NAME OF OWNER: Charlotte Mullen
OWNER MAILING ADDRESS: Mill Creek Drive W,, P.O. Box 1408
Southold, New York 11971
OWNER PROPERTY ADDRESS: Mill Creek Drive West
Southold, New York
OWNER TELEPHONE NUMBER: 516-765-2970
TAX MAP NO. : Section 51 Block 6 Lot 33
CROSS STREET: Richmond Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
Judith T. rry
Southold Town Clerk
DATE: December 2, 1987
(TOWN SEAL)
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OFFICE OF THE TOWN CLERKc3�FFO
Town of Southold �o µ CQ Application No.
Judith T. Terry, Town Clerk . __
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Town Hall, 53095 Main Road �, Residential
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P. O. Box 1179 xa'•'-c � Non-Residential
Southold, New York 11971 O ` '0���`
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Telephone • '�
(516) . 765-1801 = 1
TOWN OF SOUTHOLD
SOUTHOLD
liEctiVED
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
NOV 231" 7
Fawn Clark Southold APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /602g--
DATE I/1,9 OR?
OWNER NAME: 0, 1i r10wllen)
OWNER MAILING ADDRESS: m Ft( DriVn� W) PO Ox f6-fDR
66«-rrii. <d - Al W r g l!q 7
OWNER PROPERTY ADDRESS: M iI are-PK r)rue,
oDGe 'L.k/ A/eep //?7,/
OWNER TELEPHONE NUMBER:
TAX MAP NO. : Section S/ Block Lot -Y-3
CROSS STREET: e,tr y, ,, ort G( ,e0 Ad
TYPE OF SYSTEM: Septic Tank / New Existing
Cesspool V New Existing ✓
Residential ✓ Non-Residential
DATE OF PREVIOUS PUMP-OUT: ./op//P7
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:
RECELVEDJwn Clerk's Office
DATE: DEC 02198?
'Wm Clerk Southold ,
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