HomeMy WebLinkAboutNolan (3) OFFICE OF THE TOWN CLERK • c51FOL'C+�
Town of Southold rT=- ��
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road
P. O. Box 1179 Or,
Southold, New York 11971 `gyp44
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Telephone Ol gig II
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 392 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool X
NAME OF OWNER: Patrick Nolan
OWNER MAILING ADDRESS: Box 262
Southold, New York 11971
OWNER PROPERTY ADDRESS: 925 Oaklawn Avenue
Southold, New York 11971
OWNER TELEPHONE NUMBER: 516-765-5412
TAX MAP NO. : Section 63 Block 7 Lot 2
CROSS STREET: Route 25 - Jernick Lane
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: June 1985
Ju id th T. ' rry
Southold Town Clerk
DATE: August 11 , 1987
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(TOWN SEAL)
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OFFICE OF THE TOWN CLERK
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Town of Southold �% CQ Application No. �Y
Judith T. Terry, Town Clerk Z 5e V:,r
., << �4 1 Residential
Town Hall, 53095 Main Road .--"---
53' -Y.1', 1
P. O. Box 1179 _ -4, - ` '. .$
. Non-Residential
Southold, New York 11971 ®ii- ` F.O,�` •
Telephone -7.°1 NIP:,.
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ JO
DATE A3 l (v ?
OWNER NAME: S L N ®(_c/)r
OWNER MAILING ADDRESS: ,-0 6D ) 2---0---"
Sackt-OCd 1 (617/
OWNER PROPERTY ADDRESS: Lc C� a_()) Ve_
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OWNER TELEPHONE NUMBER: X65 ' 7h-Irl.---
TAX MAP NO. : Section 0(03 , Go Block 07,,00 Lot 002- t0CZ
CROSS STREET: ( -Z 2.-6- le \Al_In`
TYPE OF SYSTEM: Septic Tank V New Existing
Cesspool / New Existing /
Residential Non-Residential ,
- DATE OF PREVIOUS PUMP-OUT: °' Q_ ( Crg
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.)
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Signature of Applicant
RECEIVED BY: G _ L�62
Town CI rk's Offi e
DATE: , 1/. 1c67
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