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HomeMy WebLinkAboutCavanagh (2) , m I��®�®suFFOur ELIZABETH A.NEVILLE Town Hall, 53095 Main Road TOWN CLERK 1 ® 1 P.O. Box 1179 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS4711 Fax(516) 765-1823 MARRIAGE OFFICER �� ✓° 40\••of. Telephone(516) 765-1800 RECORDS MANAGEMENT OFFICER 4RI it FREEDOM OF INFORMATION OFFICERa ����� ,�� OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 3779-R Residential X Non-Residential Fee $ 10.00 New Existing X Name Of Owner CAVANAGH, JOSEPH Mailing Address 1 1945 BROADWATERS ROAD Mailing,Address 2 City St Zip CUTCHOGUE NY 11935-0000 Property Address 1 1945 BROADWATERS ROAD Property Address 2 City St Zip CUTCHOGUE NY 11935-0000 Owner Telephone No. 516-734-6647 Tax Map No. section 104.00 block 11 lot 1 .008 Cross Street HAYWATERS ROAD Issue Date: 3/27/98 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) ...__ _ i ,. ,--... Yj) 2 ? ~OFFICE OF THE TOWN CLERK ,,c3VFFU J TOWN OF SOUTHOLD • 0�, �lj �� Application No. ELIZABETH A.NEVILLE,TOWN CLERK i' "�„ -,i 154. 11 1) $10.00 - Residential - P.O.BOX 1179 -}'� ` ` SOUTHOLD,NEWYORK 11971 �'r :.'n'° ..•••�, $25.00 - Non-Residential Telephone = 1 i y1 01 (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ • J/ l DATE /C ( ©S CAvyAli\i(k -( OWNER NAME:c--3 � c i OWNER MAILING ADDRESS: (ion GI ice)At.tm--F-�e/S P.a, OWNER PROPERTY ADDRESS: OWNER TELEPHONE NUMBER: 743 6_2,62 TAX MAP NO. : S ^ction /o '`'l Block /7 Lot / e CROSS STREET: , 01---mier TYPE OF SYSTEM: Septic Tank New Existing ' Cesspool New Existing Residential Non-Residential 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.) ' -AM -- -71k, lAikkillimp- . 44 Sig ature o Ate?cant J, I Y= \ ( RECEIVED BY: 1,4-//, 1 ., i Town Cie, s Office DATE: g