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JUDITH T. TERRY y �; Town Hall, 53095 Main Road
TOWN CLERK P.O.•� Box 1179
REGISTRAR OF VITAL STATISTICS l( .�` Southold, New York 11971
MARRIAGE OFFICER ® ��, 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. 1993-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner DE DALMAS, GU I LLAUME
Mailing Address 1 P. O. BOX 328
Mailing Address 2
City St Zip ORIENT NY 11957-0000
Property Address 1 2300 VILLAGE LANE
Property Address 2
City St Zip ORIENT NY 11939-0000
Owner Telephone No. 516-323-3858
Tax Map No. section 26.00 block 1 lot 14.001
Cross Street WILLOW STREET
Date Of Last Pump Out 0/00/00
Issue Date: 10/19/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
i
OFFICE OF THE TOWN CLERK 'c�VFFO(,rrC
Town of Southold , r.,. Q ' Application No. ��/ ��
Judith T. Terry, Town Clerk .` 24=`;';1 �+
Town Hall, 53095 Main Road :< I $10.00 - Residential
,�, ,rte,
P. O. Box 1179 `'
u' t2,�� � {�'',•�' ` $25.00 - Non-Residential
Southold, New York 11971 Ogib -4'10;.•
Telephone9
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE 1 31 I I Z_
OWNER NAME: CUaAUnE Qom_ ,6ALfIS
OWNER MAILING ADDRESS: 2 I 'l �L[Qn� P0 )' 326
gRico' ( 1q�7
OWNER PROPERTY ADDRESS: - � iiv►� atcrti�
OWNER TELEPHONE NUMBER: 22-3 3
p�� 49 b__ o �- (144--, 6�-�-`
TAX MAP NO. : Section (\f Afk- Block Lot N �-
'CROSS STREET: orb Cuss St
TYPE,,OF_SYSTEM: Septic Tank New Existing
Cesspool ,y New Existing
Residential Non-Residential_
DATE OF PREVIOUS PUMP-OUT: 7 191L
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°)
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RECEIVED :BY: CE D
Town Clerk's Office
OCT1 9 1992- -- - - . - -- - - ---- -- __ ---- - -- - - - - --
DATE: "
Town Clerk Eo-utfielit
JUDITH T. TERRY ,1"F**= _
I ' , _�i°_' * Town Hall 53095 Main Road
TOWN CLERK .� YI` s' P.O. Box 1179
? �.
REGISTRAR OF VITAL STATISTICS " -r ' c Southold, New York 11971
Fax 516
MARRIAGE OFFICER • ,''' ,; " "�'m. ( ) 765-1823
:�. • ; , 4„ P�, , Fax
(516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
September 15, 1992
Guillaume DeDalmas
155 West 70th Street, Apt. 7E
New York, New York 10023
Re: 26-1-14.1 8-92
2300 Village Lane
Orient, New York
Dear Mr. DeDalmas:
Our records indicate that you recently had your cesspool/septic tank system
pumped out. According to the Southold Town Scavenger Wastes Ordinance,'
any owner of an operating, on-site sewage disposal system, such as a septic
tank or cesspool, must obtain an Operation Permit for that system.
The Operation Permit is issued by the Southold Town Clerk's Office. The
fee is ten dollars ($10.00) for a residential system, twenty-five dollars ($25.00)
for a non-residential system. You will not be asked to obtain an Operation
Permit each time you have work done on the system. The permit is only issued
once for each system.
Enclosed is an application for an Operation Permit. Please complete the
application and return it to this office along with the. location map and proper
fee. (NOTE: The location map may be a copy of your survey with the location
of the cesspool(s) indicated or a sketch of your property showing the location
of the buildings, cesspool system, and approximate distance in feet to buildings
and closest road.) Also included is an Informational Bulletin regarding the
Southold Town Scavenger Waste Treatment Facility. I hope this will aid you
in understanding the Scavenger Wastes Ordinance.
Please do not ignore this request. Should you have any questions or need
any assistance with the application, please do not hesitate to contact this office.
We will be happy to assist you in any way we possibly can.
Very truly yours,
•
Judith T. Terry
Southold Town Clerk
Enclosures (2)
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