HomeMy WebLinkAboutBrady OFFICE OF THE TOWN CLERK 0,<,1'°fc- 'Fa(,�{l,�
Town of Southold �J`'. aG
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road ' AF ' '"t.
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P. O. Box 1179afl `
Southold, New York 11971
Telephone '
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(516) 765-1801 /iv
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 558 Residential x
Fee $ 10.00 Non-Residential
Septic Cesspool x
NAME OF OWNER: Warren B. and Mary S. Brady
OWNER MAILING ADDRESS: 3500 Private Road #13
Mattituck, New York 11952
OWNER PROPERTY ADDRESS: 3500 Private Road # 13
Mattituck, New York
OWNER TELEPHONE NUMBER: 516-298-8003
TAX MAP NO. : Section 105 Block 1 Lot
CROSS STREET: Ruth Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
Judith T. T ry
Southold Town Clerk
DATE: January 4, 1988
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK .*���� _
Town of Southold ' �` � CQG' , Application No. �i�
Judith T. Terry, Town Clerk
-- Residential
53095 Main Road
Town Hall, c `Ar, ;�-�, '
P. 0. Box 1179c Non-Residential
Southold, New York 11971 ®� ���
Telephone ,
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER- DISPOSAL DISTRICT
APPLICATION
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for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.5 7'
Fee $ /o:
DATE /2/117
50 OWNER' �J OWNER NAME: 8,0„tw,tie3
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OWNER MAILING ADDRESS: 3,S:::760 cP126(.), J 4-P , /3
,177 ✓Te/c-"r f /UV. 1/9:374.-)
OWNER PROPERTY ADDRESS: ..514-17'4,
OWNER TELEPHONE NUMBER: .S-G6-01 P.�'- fd0.-3
TAX MAP NO. : Section / Block Lot �Ac°Q��
CROSS STREET: Grit/ �c.)4-A
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing et
Residential l/ Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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.) ^Gr/ •
Signature of ApOolicant
RECEIVED BY: 044 ria
W M wn rerk's 0 ice
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DATE: ,'4i41 Q®
Trnnm Clark Southold V
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