HomeMy WebLinkAboutMagill SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4372-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner MAGILL, ALFRED & MARY
Mailing Address 1 700 GLEN COURT
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Mailing Address 2
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City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 1145 FLEETWOOD ROAD
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Property Address 2
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City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 631-734-8124
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Tax Map No. section 137.00 block 4 lot 2.600
Cross Street BETTS STREET
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Issue Date: 4/28/08 Elizabeth A. Neville
------ Southold Town Clerk
(TOWN SEAL)
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ULIZA.SETH A. NEVILLE h`1` G.y Town Hall, 53095 Main Road
TOWN CLERK p� P.O. Box 1179
H = .Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER �aO� Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER � southoldtown.northfork.net
OFFICE OF THE TOWN CLERK 14 o2 0
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
OPERATION PERMIT
CESSPOOL or SEPTIC TANK Z
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Residential @ $10__X_or Non-Residential @ $25 Application No.
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Permit No. 3'D 3 0
3177
Owner Name 4 r elZD 4--
Owner Mailing Address `700 6Z&-,-hJ L�oJ2.r—
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Owner Property Address //Vs' fL�-�i"�✓��-O �o.�
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Owner Telephone No. '1!�_?/- 73 Y- ®/Z
Tax Map No: /000 Section /_77 Block o y Lot Z
Cross Street TTS
Please check each that applies: New Construction X
Alteration to Existing System
Residential '` Non-Residential
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. (Locate
building and system; give north arrow and approximate distance in feet from system to building
and closest road. New construction may submit copy of survey with SCHD approval.)
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Signature of Applicant Date
Received by:
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