HomeMy WebLinkAboutColahan 404°6440;
JUDITH T.TERRY :: '. eg Town Hall,53095 Main Road
TOWN CLERK cei ;: g P.O.Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS 1
MARRIAGE OFFICER Fax(516)765-1823
‘- Fax® 11
® �1 Telephone(516)765-1800
RECORDS MANAGEMENT OFFICER ': � � � �
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3388-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner COLAHAN, JANE
Mailing Address 1 163 BRIXTON ROAD
Mailing Address 2
City St Zip GARDEN CITY NY 11530-0000
Property Address 1 9480 NASSAU POINT ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-5957
Tax Map No. section 118.00 block 6 lot 7.000
Cross Street BRIDGE LANE
Issue Date: 10/04/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
t J sy` I, "I
OFFICE OF THE TOWN CLERK c31Fair -
Town of Southold � CQt� Application No. 3 3 ?,57.
Judith T. Terry, Town Clerk .� :� �-
Town HaiL4 53095 Main Road $10.00 - Residential
1P. O. Box 1179 � ; ,$2500 - Non-Residential
Southold, New York 11971 O ® �O.kr$
Telephone l *
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
,OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE
OWNER NAME: 'V i4H l- al7,4 //i09A/
OWNER MAILING ADDRESS: lb b if/X / OW ,10
OWNER PROPERTY ADDRESS: `�*7O: /1/i $ 4,1 f% /0
PreAide—' U6, 4/Y firbi
OWNER TELEPHONE NUMBER: s/6 7 ' ( ("7
TAX MAP NO. : Section Block Lot
CROSS STREET:
TYPE OF SYSTEM: Septic Tank _ - New '
• Existing
Cesspool l/ r` New Existing
Residential •,V 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 ad.)
Signature of Applicant
RECEIVED BY:, Aj 'L✓
- Town' Clerk's Office
DATE: /6r 73-(F.�
p
L L. --- 9 2
A)::
_______L____a a- 41/4
b
•
L1 id rr� �t � � 1=La=, �C.IC'dl,_:: LINE ® ® -- — s� r,
ti Cr! 5r1a o
PW- te
w ; A if- NI''T
1'
- A B +6-`- �N_ L-- V
ra Jed �; ���,� i
a > g !i
1 ez - N.9 r
i t=om pro. �; L 0 T q f i nr
��� ,�
r a r d -- 1" d j,
�« J �,� ,�`�C ?rte ti .
t� ' viiid �� R 5
a Gam®
ii.
J Aa — 4Ci.t� ��
s , `J /
,
o
r; ,
65i:.'I:t3 i- .-i_ toCIAP A QF a`4 : ` .,AL ,
M,AP", lJt� )m 3 ._'�ii� t k -;v' C--1 IN/ '' " IL-EU tt2 5Ur'6=3L-6a (.0 . /
I,
S'...;:h!.',/F..''T r.L ...
PE Eel C C . I�,1\f.2 L . U.: \,/i:ft ) i--
_____--
AT
1e '/ �J.',uf:A:I ! .eE-v TO Tlet E -T-,Tt E C.7UAIf-Fjte rCe_-
NAA i----.,3 f• e 1 f
CO, :,.4J . vt!7-,f..% 0 `roltNbc '.F-it•,a.
TOe^1N • OF ,:—.;.-1 ,i: