HomeMy WebLinkAboutDBM Co (34) hisridoto ..o,
JUDITH T. TERRY �,r v a, Town Hall, 53095 Main Road
TOWN CLERK t 4• K " P.O. Box 1179
REGISTRAR OF VITAL STATISTICSSouthold, New York 11971
`
MARRIAGE OFFICER �Y Fax (516) 765-1823
� �// �
•�. Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1740-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New X Existing
Name Of Owner D B M CO.
Mailing Address 1 P. O. BOX 2130
Mailing Address 2
City St Zip GREENPORT NY 11944-0000
Property Address 1 425 TUTH I L ROAD EXT.
Property Address 2 H I GHPOI NT MEADOWS LOT #13
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-477-2223
Tax Map No. section 445.00 block 6 lot 15.016
Cross Street ORIOLE DRIVE
Date Of Last Pump Out 0/00/00
Issue Date: 8/27/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
• „.
OFFICE OF THE TOWN CLERK �FFOur•'-
Town of Southold CQ Application No. /7V0
Judith T. Terry, Town Clerk . �� I �►� /
'� � �) $10.00 - Residential c�
Town Hall, 53095 Main Road
P. O. Box 1179 v' �' _' z $25.00 - Non-Residential
Southold, New York 11971 O ® •kr�`�
Telephone I% •
(51 6) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL \ �-
O:: tiotermit
raPNo. D p-„-
$ •
�"�
DATE 8/19/91
OWNER NAME: V B M Co.
OWNER MAILING ADDRESS: P. U. Box 2130
GneenpoJr t, N.Y. 11944
OWNER PROPERTY ADDRESS: 425 Tuthti.P.2 Rd. Ext. (Lot 1113 Htighpotiwt Meadows)
Souwhofd, N.Y. 11971
OWNER TELEPHONE NUMBER: 516-477-2223
TAX MAP NO. : Section 55.00 Block 6 Lot 15.016
CROSS STREET: ()trio.2e Wave
TYPE OF SYSTEM: Septic Tank - New Existing
Cesspool New X Existing
Residential X 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.)
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE: