HomeMy WebLinkAboutDavids oo'cOf Wire;
Town Hall, 53095 Main Road
w'® •' P.O. Box 1179
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® Southold, New York 11971
JUDITH T.TERRY TELEPHONE
TOWN CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 721-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner DAVIDS, ROBERT L.
Mailing Address 1 BOX 2
Mailing Address 2 NORTH ROAD
City St Zip GREENPORT NY 11944-0000
Property Address 1 NORTH ROAD
Property Address 2
City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 516-477-1876
Tax Map No. section 34. 00 block 2 lot 2. 000
Cross Street BAILEY AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 6/01/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK �FFO - `
Town of Southold ‹%��: 4' .1_ Application No. l
Judith T. Terry, Town Clerk .� ax; /
Town Hall, 53095 Main Road ,,'Z=.� Residential /
P. 0. Box 1179 Mita Non-Residential
Southold, New York 11971
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Telephone 1 • '
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ (O
DATE 6 S -z t-- g e
OWNER NAME: R L _ 'h
OWNER MAILING ADDRESS: Rix JJ® vhad
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OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: /777- /,� 6
TAX MAP NO. : Section "seBlock Lot
i0 3 L, -- .2_,
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential l- " Non-Residential
DATE OF PREVIOUS PUMP-OUT: Fro
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.)
tatid
Signature of Applicant
RECEIVED BY. - ?L
A
EC 7 `_'> own/Clerk's Office
DATE: )I,f', 011908
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