HomeMy WebLinkAboutHerbert (2) CORRECTED PERMIT
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g�� Town Hall, 53095 Main Road
;�® ��% P.O. Box 1179
-- ®1 41 .�`a®��' Southold, New York 11971
JUDITH T.TERRY � 1 TELEPHONE
TOWN CLERK (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. 662-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner HERBERT, DR. PEARL L.F.
Mailing Address 1 5655 COX LANE
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 5655 COX LANE
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-298-8785
Tax Map No. section 84. 00 block 4 lot 2.000
Cross Street ROUTE 48 (CORNER LOT)
Date Of Last Pump Out 0/00/00
Issue Date: 3/29/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
100 • •ice i
OFFICE OF THE TOWN CLERK J�J�FO(�
Town of Southold % CQ, Application No. ‘' 2-
Judith
Judith T. Terry, Town Clerk . � } � 4%` Residential
`
Town Hall, 53095 Main Road r u .
P. O. Box 1179 cnr : Non-Residential
Southold, New York 11971
Telephone Y► '°
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for -
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
�L
Fee $ 1 t -r
- DATE March 25, 1988
OWNER NAME: Dr. Pearl L.F. Herbert
OWNER MAILING ADDRESS: 5655 Cox Lane, Cutchogue, N.Y. 11935
OWNER PROPERTY ADDRESS: (same)
OWNER TELEPHONE NUMBER: 516-298-8785
TAX MAP NO. : Section Block Lot
CROSS STREET: Rt. 48 & Cox Lane S/W corner
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ******* New Existing ********
Residential ****** Non-Residential
DATE OF PREVIOUS. PUMP-OUT: April 26, 1987
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.)
Q-cLB3 _
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Signature of Applicant
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RECEIVED BY:
Town Clerk's Office
DATE: --