HomeMy WebLinkAboutDunhuber Town Hall, 53095 Main Road
t.M? ��- P.O. Box 1179
= , , ®Ii!' Southold, New York 11971
JUDITH T.TERRY ��®� FAX(516)765-1823
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��� TELEPHONE(516)765-1801
TOWN CLERK
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. 1358-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner DUNHUBER, LORRAINE T.
Mailing Address 1 28 WEST DEVONIA AVENUE
Mailing Address 2
City St Zip MT. VERNON NY 10552-0000
Property Address 1 875 FLEETWOOD ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 914-664-0439
Tax Map No. section 137.00 block 5 lot 7.000
Cross Street BETTS ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 1/10/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK ' •0FO(/-.'- _
Town of Southold - �% s--• QApplication No. /3
Judith T. Terry, Town -Clerk " ` a j;`A :, r �') $10.00 - Residential
Town Hall, 53095 Main Road �j ;--
p. 0. Box 1179 iii‘ Y_A4 $25.00 - Non-Residential
Southold, New York 11971 O ® * -4,'
Telephone ,0I• `A�
(516) 765-1801
TOWN OF SOUTHOLD
Lf2)-(T(25-1.-koOUTHOLD WAST f/ATER DISPOSAL DISTRICT
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1 OPERATION PERMIT
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SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
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DATE Z/*)
OWNER NAME: •
OWNER MAILING ArEL
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( Z Ne''a'On, /O�Alnl`R DDf�DCR eapt `. '_ '1- t i ' Ifit
bioi $ .6t-t-t' P-6
OWNER TELEPHONE NUMBER: 4-- / - 1
TAX MAP NO. : Se ion o of
CROSS STREET: 0 r- ,,,wI -,1
- 1 .
TYPE OF SYSTEM: Se tic Tank New Existing
9
Cesspool ✓ ,- New Existing t/
Residential J Non-Residential
• DATE OF PREVIOUS PUMP-OUT: 1,---aite.....14(L,Kaj....-c,...--
LOCATION
MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to build'i g and closest road.)
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�,� "C-'t,, v Signature of Applicant �.
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, 0 RECEIVED BY: IL ` ii i
lwn Clerk's Office '"'��
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DATE: /7Cr`J ,(j
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