HomeMy WebLinkAboutO'Connor (2) `a e Town Hall, 53095 Main Road
r
,�� P.O. Box 1179
$$$t Southold, New York 11971
JUDITH T.TERRY = i.%' 't FAX(516)765-1823
- � �` TELEPHONE(516)765-1801
TOWN CLERK
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. 1377-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner O'CONNOR, DIANE
Mailing Address 1 651 EAST 14TH STREET
Mailing Address 2
City St Zip NEW YORK NY 10009-0000
Property Address 1 1620 KING STREET
Property Address 2
City St Zip ORIENT NY 11957-0000
Owner Telephone No. 212-260-5963
Tax Map No. section 26.00 block 2 lot 41 .000
Cross Street NARROW RIVER ROAD
Date Of Last Pump Out 0/00/81
Issue Date: 2/07/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
.1
OFFICE OF THE TOWN CLERK ��
OFD(,( ,
Town of Southold V BO - Application No. 1731-1-
Judith
1 1-Judith T. Terry, Town Clerk 671 0 4 $10.00 - Residential
Town Hall, 53095 Main Road1 if
P. O. Box 1179 cr2 � ,ri •
. � ��,,�; • $25.00 - Non-Residential
Southold, New York 11971 ® ,e'
Telephone
(516)
�� ���
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. J
Fee $ lU ) vCJ
DATES / °/g6'
'OWNER NAME: C0NNor •
•
OWNER MAILING ADDRESS: 6S7 S% / 61-4\
OWNER PROPERTY ADDRESS: /6 /4---; '"F-
OWNER TELEPHONE NUMBER: 2 ( )- )__Cr) x,63
TAX MAP NO. : Section cat,e Block Lot 1
CROSS STREET: 4_11 AL •
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential1
DATE OF PREVIOUS PUMP-OUT: / 7g/
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.)
YI,-J=tia. C D > r L/
VV Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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