HomeMy WebLinkAboutMurray (3) iessy7r[11Q1reb
Town Hall, 53095 Main Road
kVA 44- P.O. Box 1179
4®� *4-' 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. 1421-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner MURRAY, MARIA
Mailing Address 1 28 WASHINGTON AVENUE
Mailing Address 2
City St Zip GREENPORT NY 11944-0000
Property Address 1 KENNY'S ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-477-2390
Tax Map No. section 59.00 block 2 lot 16.000
Cross Street SOUNDVIEW AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 3/19/90 Judith T. Terr,
Southold Town Clerk
(TOWN SEAL)
s �
OFFICE OF THE TOWN CLERK '
s�F �F� � fI\
Town of Southold t, � Application No.`
Judith T. Terry, Town Clerk *-' y
°A.: C $10.00 - Residential
Town Hall, 53095 Main Road ,M. `_,
P. 0. Box 1179 Y, y� Ly hzi
aA.,r, �� $25.00 - Non-Residential
Southold, New York 11971 P;'622,
Telephone •
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE ---)/�9
OWNER NAME: ./17A)) /fRi-0
OWNER MAILING ADDRESS: ole 14/4.5-1-1i/UG7'7 ,
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OWNER PROPERTY ADDRESS: / iU4)/±
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OWNER TELEPHONE NUMBER: /-/7'7
TAX MAP NO. : Sec ion ..3 f Blo Lot
CROSS STREET: l I / (J 'K ,
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ,V New Existing '
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: /l6`9D
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.)
Sture o Applican
RECEIVED BY:
Town Clerk's Office
DATE:
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