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HomeMy WebLinkAboutBrennan r ••_‘136 00 JUDITH T.TERRY ; $ ��; Town Hall, 53095 Main Road TOWN CLERK • ` P.O. Box 1179 ci2eam - ? �� Southold,New York 11971 REGISTRAR OF VITAL STATISTICS .\ ® fi . Fax MARRIAGE OFFICER Fax(516)765-1823 �s� RECORDS MANAGEMENT OFFICER i too Telephone(516) 765-1800 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. 3750-R Residential X Non-Residential Fee $ 10.00 New Existing X Name Of Owner BRENNAN, SHEILA A. Mailing Address 1 800 PARK AVENUE Mailing Address 2 City St Zip MANHASSET NY 11030-0000 Property Address 1 1565 BRIGANTINE DRIVE Property Address 2 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 516-622-8622 Tax Map No. section 79.00 block 4 lot 57.000 Cross Street NORTH BAYV I EW Issue Date: 12/31/97 Judith T. Terry Southold Town Clerk (TOWN SEAL) P ;IF 110 V,, OFFICE OF THE TOWN CLERK COF�(,r' - Town of Southold 0�� • „ M �'Q t� Application No. 3 750 Judith T. Terry, Town Clerk Town Hall, 53095 Main Road ;< $10.00 - Residential P. O. Box 1179 Telephone �r '? { •hZi ;' $25.00 - Non-Residential Southold, New York 11971 O' O '�' .1%:\9” O F/ .( (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT • SEPTIC TANK or CESSPOOL Operation Permit No. 75 Fee $ /2 DATE iQ.�c__ 4?,/ 797 OWNER NAME: , g,.) ,q, A///' ) • OWNER MAILING ADDRESS: g® 6 Jo/1-,to/v' ,q V4 /174 A/19 38 7'' 'v y 3 OWNER;.-PROPERTY ADDRESS_:_. •13'60.- ,JEJct "WTkA) De/ / 9 `� � OWNER TELEPHONE NUMBER: S-1 TAX MAP NO. : Section 7 9 Block '7' Lot 5 CROSS _STREET: /VO,Q 2 N- . (l 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.) a � Signature of Applicant RECEIVED BY: je:,(9...{97e2:€,L/ Town Clerk's Office. 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