HomeMy WebLinkAboutCassidy (2) ,
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Town Hall, 53095 Main Road
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P.O. Box 1179
- ,ss22, Southold, New York 11971
JUDITH T.TERRY ®� mss' i�� TELEPHONE
TOWN CLERK (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. 878-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner CASSIDY, MARY LOU
Mailing Address 1 645 HOLDEN AVENUE
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 645 HOLDEN AVENUE
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-5243
Tax Map No. section 110.00 block 5 lot 51 .000
Cross Street DICK'S POINT ROAD
Date Of Last Pump Out 0/00/83
Issue Date: 10/07/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK c0FUL -"' ��
Town of Southold % x. C'�' Application No.
Judith T. Terry, Town Clerk ���Otf '-1,
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Town Hall, 53095 Main Road c z` k ?• x Residential
P. O. Box 1179 cra �, � t
� � �y,����,• � Non-Residential
Southold, New York 11971 ® '`® �'�>
Telephone Va.,—01
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE l O
r
/FY
OWNER NAME: (Ii 1R--Y (0V C1510
sr
OWNER MAILING ADDRESS: C 7 /Jvt, iiI $"
Cu — 6 — /G9 TS
OWNER PROPERTY ADDRESS: 3,4I�
OWNER TELEPHONE NUMBER: 7 3 V S---2-4/ 7 0
TAX MAP NO. : Section ii 6 Block c Lot Cl
CROSS STREET: /9(C' fO/-V7- a0,0-1)
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential 4---- Non-Residential
DATE OF PREVIOUS PUMP-OUT: /7J2
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.)
--7- 1111"
Sig ture of ppli ..nt /
RECEIVED BY: (4-7 c2//,_.-- ( 1-l),(-i( .-'
' Town Clerk's Office
DATE: /0 - 7-fi
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