HomeMy WebLinkAboutDBM Co (44) JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK z T • P.O. Box 1179
REGISTRAR OF VITAL STATISTICSCP .` " Southold, New York 11971
MARRIAGE OFFICER s- 406 ��444T-,.�� Fax (516) 765 1823
-- ®1 �� 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. 3073-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
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 1 500 MOCKINGBIRD LANE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-477-2223
Tax Map No. section 55.00 block 6 lot 15.056
Cross Street TUTHILL ROAD EXT.
Date Of Last Pump Out 0/00/00
Issue Date: 7/27/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK cuFFOC,(- �O
Town of Southold ra% Application No.
• ff ��,:.-,
Judith T. Terry, Town Clerk a� is
Town Hall, 53095 Main Road = ` < I $10.00 - Residential
p. O. Box 1179 crs ° ; $25.00 - Non-Residential
Southold, New York 11971 O��l�w `°0-01.
Telephone 1_.
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 073
Fee $/e7--'---
DATE
/ODATE I f -2-(2 093
4
OWNER NAME: F1 a-0
OWNER MAILING ADDRESS: (4it 3 - .M �, � 5 1 P. O . 6.0y _i
G pP T Ai )1 1-1941S1
OWNER _PROPERTY ADDRESS: N500 F'( ocl< /loci r3/e I) L eoc
.,S O u rH-o lJ Y 119 7/
OWNER TELEPHONE NUMBER: Gs- 10
TAX MAP NO. : Section S6- Block 6 Lot JS. S G
CROSS STREET: 4U TH !« i2 i . ATX Tg
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ,/ New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: /�-�111-
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.)
M, -
Pi, OA., re, _
RECEIVED BY: AZ, ZA---",--e-y
Town Clerk's Office
DATE: "7/
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SINGLE FAMILY DWELLING ONLY
EXPIRES TWO YEARS FROM DATE OF APPROVAL .
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SURVEY FOR
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, , _. ,, D.B.M. COMPANY _ -
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LOT NO.50,11HIGHPOINT MEADOWS,SECTION THREE"
. suffoUi COUNTY'DEPARTMENT Of HEALM SERVIV.:t '
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AT SOIITHC1 I) JULY 22 1991 -
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