HomeMy WebLinkAboutMullen (2) OFFICE OF THE TOWN CLERK • COM/re,:
Town of Southold lj
Judith T. Terry, Town Clerk „ VI
Town Hall, 53095 Main Road '�
P. 0. Box 1179 cr2 H"2 u,i "'t
Southold, New York 11971 ,A �- •�
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Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 345 Residential X
Fee $ 10.000 Non-Residential
Septic Cesspool x
NAME OF OWNER: Esther C. Mullen
OWNER MAILING ADDRESS: Terry Lane
Southold, New York 11971
OWNER PROPERTY ADDRESS: Terry Lane
Southold, New YOrk
OWNER TELEPHONE NUMBER: 516-765-3737
TAX MAP NO. : Section 65 Block 1 Lot 12
CROSS STREET: Hobart Avenue
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: June 1987
•
Judith T. Terry
• Southold Town Clerk
DATE: , July -15, 1987
(TOWN SEAL)
OFFICE OF THE TOWN CLERK COM '
Town of Southold �o .r�LL _.. CQG'_, Application No.37//
-C
Judith T. Terry,
Town Clerk �� `
Town Hall, 53095 Main Road a -7‹. Residential
P. O. Box 1179 crs V ,, Y �. Non-Residential
Southold, New York 11971 O kg's:, g.`
Telephone , `o
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE JvJr
OWNER NAME: k giii ffe L !"I u / I ',g/
OWNER MAILING ADDRESS: T�/Q y A A/�'
„sou rw, Ln ivy / 197/
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: 7' _ 3 7 3 7
TAX MAP NO. : Section 6-C-
Block ( Lot
CROSS STREET: ,6,Q?t 7 4zV
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ' New Existing
Residential 1/ Non-Residential
DATE OF PREVIOUS PUMP-OUT: J,' �„ p- / 9 f 7
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.)
•/ ,J<
Sig .ture of App icant
RECEIVED BY:
Town Clerk's Office
DATE:
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