HomeMy WebLinkAboutMurphy (3) OFFICE OF THE TOWN CLERK • FQ
Town of Southold ��� COI
Judith T. Terry, Town Clerk . � `': '1%1" ,
Town Hall, 53095' Main Road a - •
P. O. Box 1179 � �:: " :
Southold, New York 11971 i%6‘)Telephone 1 I
(516) 765-1.801 •
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
- OPERATION PERMIT
, SEPTIC TANK or CESSPOOL
•
Operation Permit No. 320 ' Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: ' John Murphy -
OWNER MAILING ADDRESS: P.O. Box 864
Mattituck, New York 11952 -
OWNER PROPERTY ADDRESS: Cx00 Ruth Road
Mattituck, New York
OWNER TELEPHONE NUMBER: 516-298-4464
TAX MAP NO. :- Section 106 Block 5 Lot 31
CROSS STREET: Breakwater Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing - X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: N/A
•
Judith T. Terry
Southold Town Clerk
DATE: July 14, 1987 • -
(TOWN SEAL) - !-
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OFFICE OF THE TOWN CLERK c3VFFU(,���=
Town of Southold �� x. an CD % Application No.3A
Judith T. Terry, Town Clerk
� i .G ✓
Town Hall, 53095 Main Road Residential
P. O. Box 1179 ,' ° � Non-Residential
Southold, New York 11971 O = + 7
Telephone ®.( 0
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /7)
DATE •
OWNER NAME:
OWNER MAILING DDRESS: 1)4'0, f 7
OWNER PROPERTY ADDRESS: (n 6 p Ire-AA,,
OWNER TELEPHONE NUMBER: 9 f— (ft/ c tf
TAX MAP NO. : Section /66. Block 5 Lot 8/
CROSS STREET: !,
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool t- New Existing V
Residential V Non-Residential
DATE OF PREVIOUS PUMP-OUT: ,/774
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 ppl' Jnt
RECEIVED BY:
Town Clerk's Office
DATE:
cm) 01d
45
1"