HomeMy WebLinkAboutWhelan 4911 cernin
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T�-�� Town Hall, 53095 Main Road
c 2 O Vii`' P.O. Box 1179
®� 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. 1126-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
•Name Of Owner WHELAN, DOUGLAS F.
Mailing Address 1 16232 DEER LAKE ROAD
Mailing Address 2
City St Zip DERWOOD MD 20855-0000
Property Address 1 OLD HARBOR ROAD
Property Address 2
City St Zip NEW SUFFOLK NY 11956-0000
Owner Telephone No. 301-258-0552
Tax Map No. section 117.00 block 3 lot 8.006
Cross Street NEW SUFFOLK AVENUE
Date Of Last Pump Out 0/00/75
Issue Date: 5/30/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
is
' i FICE OF THE TOWN CLERK -COFDU.
Town of Southold Application No. //d,‘
Judith T. Terry, Town Clerk Residential
µ
Town Hall, 53095 Main Road -
P. O. Box 1179 u-3 `" Non-Residential
Southold, New York 11971 Or ‘V-
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ • •
DATE S ;o/eq
OWNER NAME: 606CaZAS T-- 11/2/e=l./I/J
OWNER MAILING ADDRESS: `1,232 [_Eye xgKE RI)
l)ER IA/co6 / moi,) . a08SS
OWNER PROPERTY ADDRESS: o/�� //g28 0 20196
/J5 g(.tFFOLk N.Y- // 9 S t
OWNER TELEPHONE NUMBER: go/ - „5g - OSS-2
•
TAX MAP NO. : Section //7- Block 3 Lot g 1,
CROSS STREET: ,/,t t. c urroz..k FI✓FN uC
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool / New Existing tr
Residential V Non-Residential
DATE OF PREVIOUS PUMP-OUT: /9.pS
LOCATION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow and feet
of distance, approxima -ly, to building and closest road.)
SFE A'S7ti &//ElJ
'.nature of Applicant
RECEIVED BY:''
Town Clerk's Office
DATE:
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