HomeMy WebLinkAboutBradley ® Town Hall, 53095 Main Road
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� ® ���� P.O. Box 1179
®� ��,�' Southold, New York 11971
JUDITH T.TERRY �. ii''" FAX(516)765-1823
TOWN CLERK TELEPHONE(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. 1493-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner BRADLEY, MARGARET
Mailing Address 1 1015 FACTORY AVENUE
Mailing Address 2
City St Zip MATTTIUCK NY 11952-0000
Property Address 1 1015 FACTORY AVENUE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-5477
Tax Map No. section 122.00 block 2 lot 21 .000
Cross Street MAI ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 7/11/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
OFFICE OF THE TOWN CLERK ��
�FTO -_ fj
Town of Southold � ., C'0 Application No. f0,-
Judith T. Terry, Town Clerk 1#,• 4:-%~ `r` '�� $10.00 - Residential •
Town Hall, 53095 Main Road � ''�" '�{� :�
P. O. Box 1179 cn 4`Y`; 1y` ,
� �, t N.4.,%-e-:-t, $25.00 - Non-Residential
Southold, New York 11971 0_4:, •'`?'`i 1
Telephone -TO • ��� to
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ t° • °--°
. DATE J J l
I
OWNER NAME: H rA,,yGArs1k' g f-0A\ L
11
OWNER MAILING ADDRESS: 10 lic C..Iv� gv_,v),,,,-e
Ho3A,4-\,,,a_ 1 •'N.L , 1 t 9 2
OWNER PROPERTY ADDRESS:_ -f 1(fl'-e•—,
OWNER TELEPHONE NUMBER: 1q 2 -- 641-1-7--
., t-I1'~7--
TAX MAP NO. : Section 1 )- Block Lot ail
CROSS STREET: PkW T\ 1R\ro cAA
TYPE OF SYSTEM: Septic Tank _ New Existing
Cesspool )C New Existing A/L
Residential )<:-- Non-Residential
DATE OF PREVIOUS PUMP-OUT: , 7
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.)
/t/dip..-Ce 7, (4 //4,
Signature of Applicant
RECEIVED BYeh'Clerk's Office
DATE: V,tJl
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