HomeMy WebLinkAboutDBM Co (41) JUDITH T. TERRY : Town Hall, 53095 Main Road
TOWN CLERK v rZ >. P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
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MARRIAGE OFFICER = �` 'u ) •I�, Fax 765-15-
RECORDS MANAGEMENT OFFICER _'7®1 P�+° Telephonnee ((5516) 765 1801
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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. 3213-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner DBM CO.
Mailing Address 1 P. O. BOX 2130
Mailing Address 2
City St Zip GREENPORT NY 11944-0000
Property Address 1 1580 ORIOLE DRIVE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-1177-2223
Tax Map No. section 55.00 block 6 lot 15.042
Cross Street TUTH I LL ROAD EXT.
eg(-64°4d.
Issue Date: 6/07/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK ,
Town of Southold 44
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Oho ;_� .� CQ Application No.
Judith T. Terry, Town -Clerk"' tom, ,I
Town Hall, 53095 Main Road 8 $10.00 - Residential
P: �;"pi^O. Box 1179 u-3 � P�.�,�r � $25.00 - Non-Residential
Southold, New York 11971 4 ®
Telephone *O *® /e
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE 34 /9 k/
OWNER NAME: M Co • •
•
OWNER MAILING ADDRESS: LN3 HM-60 S 7. P . O . 20k oZv, ,o
c� R --&,o,0oir „oV 119 '11/
OWNER PROPERTY ADDRESS: J S FlO Q R -
Soo r I oL N5/ I l 9 1,
OWNER TELEPHONE_NUMBER: S-ao -
TAX MAP NO. : Section SuBlock 6 Lot .X5—, 'R
CROSS STREET: l 0 r f ii e._ I2 6---)(7-.
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ✓ New Existing
Residential ✓ Non-Residential
DATE OF PREVIOUS PUMP-OUT: ,U//14
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.)
i Signature of Applicant
RECEIVED BY: 1.
T wn Clerk's Office
DATE: 6 3 9 V