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Town Hall, 53095 Main Road
c �$ P.O. Box 1179
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Southold, New York 11971
JUDITH T.TERRY : 1 TELEPHONE
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TOWN CLERK ':`> /////ii°� (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. 945-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner DUELL, LINTON AND DIANA
Mailing Address 1 P. O. BOX 783
Mailing Address 2
City St Zip ORIENT NY 11957-0000
Property Address 1 930 VILLAGE LANE
Property Address 2
City St Zip ORIENT NY 11957-0000
Owner Telephone No. 516-323-2580
Tax Map No. section 25.00 block 1 lot 17.000
Cross Street SKIPPER'S LANE
Date Of Last Pump Out 0/00/00
Issue Date: 12/08/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF "THE TOWN CLERK CO HU(
Town of Southold % , _ %--_, Application No. 91/5—
Judith T. Terry, Town Clerk 4
Town Hall, 53095 Main Road a v -4 7 Residential 4.------
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P. O. Box 1179 to r Z Non-Residential
Southold, New York11971, O4:'''.-'''
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Telephone o.( ,
(516) 765-1801 -
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
$ /0 : -
Fee '
DATE /J//2 &/e3 S
OWNER NAME: L”ire,"/ d ilookox S Ge -// -
OWNER MAILING ADDRESS: PO. am( lg, .
OR r, Aiy. //a17-
OWNER PROPERTY ADDRESS: 93o 14//Ag 4 4,gNG
C9l�/�tri Al.1/•c! /95'7.
OWNER TELEPHONE NUMBER: 3/(, -jo,3 , a 6-gp
' TAX MAP NO. : Section a 5. Block I Lot 1 q-
CROSS STREET: Ki ppeA2. 's L ra,e_
TYPE OF SYSTEM: Septic Tank V New Existing
Cesspool New Existing
Residential 1/ - Non-Residential
DATE OF PREVIOUS PUMP-OUT: �/�d/88
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.)
7� • of Applicant
RECEIVED BY . ,e-.i . 94§- 2,0
`� '-awn C rk's Of ice
DATE: DEC 0 ; 198$
TOM Clerk Southold
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