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Town Hall, 53095 Main Road
�® P.O. Box 1179
_ ® �®.- Southold, New York 11971
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. 1089-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New X Existing
Name Of Owner MURPHY, FRANCIS AND ELIZABETH
Mailing Address 1 P. O. BOX 84
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 3325 WICKHAM AVENUE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-4975
Tax Map No. section 114.00 block 4 lot 1 .000
Cross Street GRAND AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 4/24/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
• ...
OFFICE OF THE TOWN CLERK
Town of Southold �_13 C� Application No./O
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road 4 Residential
Q g�'4 �i �{ L•
P. O. Box 1179 u' : ; Non-Residential
Southold, New York 11971 O gib
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Telephone woo
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ 10.00
DATE April 20, 1989
OWNER NAME: Murphy, Francis and Elizabeth
OWNER MAILING ADDRESS: P. O. Box 84
Mattituck, New York 11952
OWNER PROPERTYADDRESS: 3325 Wickham Avenue
Mattituck, New York 11952
OWNER TELEPHONE NUMBER: 516-298-4975
TAX MAP NO.,: Section 114 Block 4 Lot 1
CROSS STREET: Grand Avenue
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New x Existing
Residential X - Non-Residential
DATE OF PREVIOUS PUMP-OUT: N/A_'
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.)
/� :^i • t_ - of Applicant
RECEIVED BY: •
own Clerk'sOffice
DATE:
CONFORk
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