HomeMy WebLinkAboutCassidy (2) JUDITH T. TERRY �%. ® mak. . Town Hall, 53095 Main Road
TOWN CLERK �� P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ' °� i" Southold, New York 11971
MARRIAGE OFFICER Fax (516) 765-1823
�e , kv ,'` Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1710-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner CASSIDY, THOMAS P. & LORRAINE
Mailing Address 1 2150 MILL CREEK DIRVE
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 2150 MILL CREEK DRIVE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 000-000-0000
Tax Map No. section 51 .00 block 6 lot 6.000
Cross Street RICHMOND ROAD
Date Of Last Pump Out 6/00/83
Issue Date: 6/27/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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Town of Southold Application No.7 /0
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Judith T. Terry, Town Clerk $10.00 - Residential
Town Hall, 53095 Main Road 8 Cc
P. O. Box 1179 tri i` t{ �`' $25.00 - Non-Residential
Southold, New York 11971 O6A,
Telephone ' ,( `N
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE q( ? fqJ
•
OWNER NAME: 7-hornk5 P d- J.orra-ih-e L. C S5 Id`1
OWNER MAILING ADDRESS: 0-15-O o 11 C-r br; i-e.
(S)wnttda //_f, q l).
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OWNER PROPERTY ADDRESS: -e_
OWNER TELEPHONE NUMBER:
TAX MAP NO. : Section ,-.57 Block 6 Lot 6
CROSS STREET: K:c.A4 rt, o nd 12
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential ,/ Non-Residential
DATE OF PREVIOUS PUMP-OUT: �? �3
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.)
: //kll'itAV/ P
Signature of Applica
•
RECEIVED BY: •
Town Clerk's Office
DATE:
JUN 20191
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