HomeMy WebLinkAboutTangney OFFICE OF THE TOWN CLERK
Town of Southold
Judith T. Terry, Town Clerk 17-f ,I'Y
Town Hall, 53095 Main Road C'-• ' '
P. 0. Box 1179 ,;f-r`_ 4.41.4a ••
Southold, New York 11971 Q
Telephone ,�=�.[ ; t
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
•
Operation Permit No. 563 Residential X
Fee $
10.00Non-Residential
Septic Cesspool X
NAME OF OWNER: Mary Tangney
OWNER MAILING ADDRESS: 1605 Little Neck Road
Cutchogue, New York 11935
OWNER PROPERTY ADDRESS: 1605 Little Neck Road
Cutchogue, New York
OWNER TELEPHONE NUMBER: 516-734-7333
TAX MAP NO. : Section 103 Block 5 Lot 2.1
CROSS STREET: Moose Trail
TYPE OF SYSTEM: Septic Tank X New Existing x
Cesspool New Existing
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: None
JudithTT�� 3�Fy
Southold Town Clerk
DATE: January 8, 1988
•
(TOWN SEAL)
OFFICE OF THE TOWN CLERK c��FFD(,���'
Town of Southold �� CQG' Application No. SZ 3
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road - Residential
tui -
P. -O. Box 1179 `" ti Non-Residential
Southold, New York 11971 O ® � )- z•S
Telephone .(
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /b
DATE /F--k
R
OWNER NAME: f)1 /
OWNER MAILING ADDRESS: l 6 6 S L / j / o
6LTrc. - �v,- //43
OWNER PROPERTY ADDRESS:
ij
OWNER TELEPHONE NUMBER: "73 ce/7 3 3 a
TAX MAP NO. : Section /6 3 Block — Lot Z s P
CROSS STREET: /d')uUsc� T2
TYPE OF SYSTEM: Septic Tank V New Existing
Cesspool New Existing
Residential ✓ Non-Residential
DATE OF PREVIOUS PUMP-OUT: Aid41a
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.)
Signa'ure of Appli - • .�
RECEIVED BY
Town Jerk's five 4,07
DATE: , 7/ PK