HomeMy WebLinkAboutDBM Co (45) " -,
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JUDITH T.TERRY ` ® F4 � y •• Town Hall, 53095 Main Road
TOWN CLERK 4k a P.O.Box 1179
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REGISTRAR OF VITAL STATISTICS •` � Southold,New York 11971
MARRIAGE OFFICER �� trifiP' ®6 / Fax(516)765-1823
RECORDS MANAGEMENT OFFICER : ®� i. *Fos" Telephone(516)765-1800
FREEDOM OF INFORMATION OFFICER ,•0°
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3414-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner DBM CO. - SCHADE, JAMES S.
Mailing Address 1 P. O. BOX 2130
Mailing Address 2
City St Zip GREENPORT NY 11944-0000
Property Address 1 365 MOCKINGBIRD LANE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-3408
Tax Map No. section 55.00 block 6 lot 15.058
Cross Street TUTH I LL ROAD EXT.
Issue Date: 11/27/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK �C3IFO(,r`;-
} Town of Southold , O� QG:\ Application No. " //f.
.
Judith T. Terry, Town Clerk . , y
Town Hall, 53095 Main Road $10.00 - Residential [..------
P.
P. O. Box 1179 cn - - h�i ;' $25.00 - Non-Residential
Southold, New York 11971 O ���,,,
Telephone Oj � `I% �e�
(516) 765-1801 -
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. S V/ S/
Fee $ /0; —
DATE //f 3//Q 3-
OWNER
OWNER NAME: 7)3I 7 a .. `IAMC5 5 5e 44 sql>e
OWNER MAILING ADDRESS: .16aC-�,Pe/lryG3.g2P 4,47/tib-
jou.,
, Wjocc 77904/ i✓X..,, / / 97/
OWNER PROPERTY ADDRESS: 5/4-en
OWNER TELEPHONE NUMBER: 3/6' 4-75'6---9- 3 `Vc'
TAX MAP NO. : Section ,S Block Lot /cS 9
CROSS STREET: I 0-1-14 I t-(-- R 1t - - x--t- , .
TYPE OF SYSTEM: Septic Tank V New Existing
Cesspool New L. 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.)
, __ ..4.. ,..... ,
Sig, ature of Applicant
RECEIVED BY: 4>/i ALAC-A,---z-v
Town Clerk's Office
DATE: // / /e/9
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