HomeMy WebLinkAboutDurking f°1911A"' 01,42r
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JUDITH T. TERRY �1 F Town Hall, 53095 Main Road
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P.O. Box 1179
OWN CLERK
�' Southold, New York 11971
REGISTRAR OF VITAL STATISTICS �� • ���� Fax 516 765-1823
MARRIAGE OFFICER �® i ( )
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Telephone (516) 765-1801 •
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1822-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner DURKING, JAMES L. AND RUTH
Mailing Address 1 27 MADISON STREET
Mailing Address 2
City St Zip GREENPORT NY 11944-0000
Property Address 1 27 MADISON STREET
Property Address 2
City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 516-477-1671
Tax Map No. section 40.00 block 5 lot 21 .000
Cross Street WILMARTH
Date Of Last Pump Out 0/00/00
Issue Date: 12/19/91 Judith T. Terry
Southold Town Clerk
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(TOWN SEAL)
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-743F CE OF THE TOWN CLERK •c0FULte,"
Town of Southold �� CQG', Application No. /
S.
Judith T. Terry, Town Clerk � et.
Town Hall, 53095 Main Road o .0 $10.00 - Residential
P. O. Box 1179 cri it°; ' : $25.00 - Non-Residential
Southold, New York 11971 •�`
Telephone ( g
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT .
SEPTIC TANK or CESSPOOL
Operation Permit No./moi
Fee $ /0, 00
• DATE /`2'`11/F/
OWNER NAME: ,Tamps L_ & Ruth Dorking
OWNER MAILING ADDRESS: 27 Madison Street
Greenport, N. Y. 11944
OWNER PROPERTY ADDRESS: same
OWNER TELEPHONE NUMBER: 516-477-1671
TAX MAP NO. : Section 40 Block 5 Lot 91
CROSS STREET: Wi smart-h
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TYPEOFSYSTEM: Septic Tank New Existing
Cesspool x New Existing
Residential x Non-Residential
DATE OF PREVIOUS PUMP-OUT: none
LOCATION MAP: Must be attached hereto before permit maybe issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
4 Otevt./iLlrit„.e
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
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DATE:
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