HomeMy WebLinkAboutCunningham F• ( .,+moo
Town Hall, 53095 Main Road
$ P.O. Box 1179
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Southold, New York 11971
JUDITH T.TERRY ,.
TOWN CLERK 01.°. TELEPHONE
*.lr,w fO (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. 773-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner CUNNINGHAM, LORETTA
Mailing Address 1 BOX 108
Mailing Address 2
City St Zip PECONIC NY 11958-0000
Property Address 1 760 LESLIE ROAD
Property Address 2
City St Zip PECONIC NY 11958-0000
Owner Telephone No. 516-734-6997
Tax Map No. section 97 . 00 block 9 lot 4. 000
Cross Street SKUNK LANE (BAY AVENUE)
Date Of Last Pump Out 0/00/00
Issue Date: 8/01/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK c�VFFD(,�
Town of Southold 0 C'0I'• Application No. 2 .73
Judith. T. Terry, Town Clerk �� icArlAt ,
Town Hall, 53095ResidentialRoad -< Residential
P'. O. Box 1179 ; �q
. TA4,41$ Non-Residential
Southold, New York 11971 p ® =: ' ��•
Telephone . '
(516) 765-1801
TOWN OF SOUTHOLD
SOU,T,HOLD WASTEWATER DISPOSAL DISTRICT
% APPLICATION
for -
OPERATION PERMIT '
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'SEPTIC TANK or CESSPOOL
Operation Permit No. 0'1/
Fee '$ lb ;06 -
DATE lg fig$$
OWNER NAME: r)( ,.
OWNER MAILING ADDRESS: tp�
OWNER PROPERTY ADDRESS: bo `Rft,..01
OWNER TELEPHONE NUMBER: 114- 0191 --
TAX MAP NO. : Section .g Block / Lot` ."
CROSS STREET: f As+ ®F QA� ifk (SICv.+Jk LA � 1- WeS I- o r d•.; i/ c,�((
LA .
TYPE OF SYSTEM: Septic Tank New Existing tr
Cesspool - New Existing I,'
Residential ✓ Non-Residential
DATE OF PREVIOUS PUMP-OUT: �� �g FERSA- p - -
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.)
Signature of Apgnt
RECEIVED BY: •
Town Clerk's Office
DATE:
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