HomeMy WebLinkAboutBurke _.OFFICE QF THE TOWN CLERKFO C
Town of Southold
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- Judith T. Terry, Town Clerk ,Y
Town Hall,. 53095 Main Road •
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P. O. Box 1179 0
Southold, New York- 11971 k �- • . -
Telephone 01
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
•
Operation Permit No. 599 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool X
NAME OF OWNER: Michael T. and Linda J. Burke
OWNER MAILING ADDRESS: 155 Woodcliff Drive
Mattituck, New York 11952
OWNER PROPERTY ADDRESS: 155 Woodcliff Drive
Mattituck, New York 11952
OWNER TELEPHONE NUMBER: 516-298-8416 •
TAX MAP NO. : Section 107 Block 7 Lot 27
CROSS STREET: Brower Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential -
DATE OF PREVIOUS PUMP-OUT: Unknown
udith T. T y
Southold Town Clerk
DATE: February 10, 1988 -
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(TOWN SEAL)
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OFFICE OF THE TOWN CLERK S\\FFO(,r�'-
Town of Southold CQ ' . Application No.
Judith T.-\Terry, Town Clerk`
Town Hall,' 53095 Main Road Residential,
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P. O. Box 1179 G' � f,,� � . � � Non-Residential
Southold, New York 11971
Telephone ''�.!
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD. WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 2/
Fee $ ® C5/C5 ‘25-°
DATE Q ' .99"
OWNER NAME: 4' 'cA4 / /OM [iT?A"
OWNER MAILING ADDRESS: /,S5 b-)O °DC i-/Cfr Oie
,nig r77-ac k .96-°
OWNER PROPERTY ADDRESS: —
OWNER TELEPHONE NUMBER: - /Ai
TAX MAP NO. : Section /0 7 Block 7 Lot 2'7
CROSS STREET: Tie.0wg.e.. ,p,4p
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: a /ex,0 w.�J
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.)
Signature of Applicant
Med-i" /MI6
RECEIVED BY: G z1.-
Town CleIk's O
DATE: ��'
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