HomeMy WebLinkAboutCallinan II' CP CP DL k ®
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Town Hall, 53095 Main Road
1 P.O. Box 1179
_ ® ��: �►�" Southold, New York 11971
JUDITH T.TERRY 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. 1173-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner CALLINAN, JOHN W. & SHARON R.
Mailing Address 1 9010 ROSEWOOD LANE
Mailing Address 2
City St Zip MAPLE GROVE MN 55369-0000
Property Address 1 2200 HOBART ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 612-420-4430
Tax Map No. section 64.00 block 3 lot 6.000
Cross Street SHIPYARD LANE
Date Of Last Pump Out 0/00/00
Issue Date: 6/26/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK l\FFU
Town of Southold `' 7/
� � Application No.
Judith T. Terry, Town Clerk �`' w " y
Town Hall, 53095 Main Road Residential
P. O. Box 1179 cry moi ;` Non-Residential
Southold, New York 11971 ® o't O��P
Telephone . I
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $/61
DATE
OWNER NAME: f LV. 4. VL irCY9 , /j, VI`o
OWNER MAILING ADDRESS: 76/0 ®,S'�GJ'do'c6,
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OWNER PROPERTY ADDRESS: c2 O er-/- /Fe oat
'A111o1 NI 1/ 7/
OWNER TELEPHONE NUMBER:(/ /a?) ,V® - Vj®
TAX MAP NO. : 'Section q Block Lot -
CROSS STREET: p (Ao.x-ci k e_,
9 e
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential ,,)(- Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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:
Town Clerk's Office
DATE:
JUN 2 6 1869 .
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