HomeMy WebLinkAboutDubner OFFICE OF THE TOWN CLERK •-' FU - •
Town of Southold ��� C�G
- Judith T. Terry, Town Clerk �*t L�
Town Hall, 53095 Main Road
P. 0. Box 1179
Southold, New York 11971 ®}'"$. 0�- •�
Telephone _ 0t
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT .
SEPTIC TANK or CESSPOOL
Operation Permit No. 420 Residential X
Non-Residential
- Fee $ 10.00
Septic Cesspool X
- NAME OF OWNER: Steve Dubner
OWNER MAILING ADDRESS: 690 Deer Park Avenue
Dix Hill, New York 11746
OWNER PROPERTY ADDRESS: Cox Lane
Cutchoque, New York
OWNER TELEPHONE NUMBER: 516-242-4914
TAX MAP NO. : Section 84 Block 4 Lot 6.1
CROSS STREET: Middle Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New X Existing
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: N/A
1udi+1h T Terry
Southold Town Clerk
DATE: September 2, 1987
(TOWN SEAL)
.00
OFFICE/. OF ;HE TOWN CLERK c�FF�(A. '_-
Town of SoutholdCSG Application No.
Judith T. Terry, .T4,n.n-�Clerk .` �.' y
Town Hall, 53095 Main Road ';
< Residential
P. O. Box 1179 �' " s.; .`' Non-Residential
Southold, New York 11971 Off` •
�
' _£ :0`���`�
Telephone _0/ t; 1's•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.I
Fee $ 11) ° %c.)
•
DATE 7 _
OWNER NAME: ATE 0i~ C)1 1'al\J tiR
OWNER MAILING ADDRESS: (°1 () QE 1r NZ 9,-)9"(R1 Jv 2
QM/ l4 , 11% INy I1721t
OWNER PROPERTY ADDRESS: Co )(
QA.A,T c 1-1 D c,u
OWNER TELEPHONE NUMBER: 6--R, -
TAX MAP NO. : Section c.K2-/ Block Lot (9 - l
CROSS STREET: 9
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New ✓ Existing
= Residential ✓ Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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.)
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
1
r"
OFFICE pF TIE TOWN CLERK c.OFULA'
tx-
Town or Southold �lj
Judith T. Terry, Town Clerk �`
Town Hall, 53095 Main Road
P. O. Box 1179 u `
Southold, New York 11971 c �`�,
Telephone 1 i '
siz
(5161 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC T'AN'K or CESSPOOL
Permit No. 100 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool X
PERMIT ISSUED TO:
NAME: Steven Dubner
ADDRESS: 690 Deer Park Avenue
Dix Hill, New Y6?rk 11746
DESCRIPTION OF PROPOSED CONSTRUCTION or ALTERATION •
One story, single family dwelling
LOCATION OF PROPOSED CONSTRUCTION or ALTERATION:
OWNER OF PROPERTY: Steven Dubner
OWNER MAILING ADDRESS: 690 Deer Park Avenue
Dix Hills, New York 11746
OWNER PROPERTY ADDRESS: Cox Lane
Cutchogue, New York
TAX MAP NO. : Section 84 Block 4 Lot 6.1
CROSS STREET: Middle Road
BIJILD!NG__PERM!T NUMBER CROSS REFER-EN-CE:-- Unavailable----
111-4,---
Judith T. Terry
Southold Town Clerk
DATE: January 27, 1987
(TOWN SEAL)
'11
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