HomeMy WebLinkAboutHubbard (2) 00014
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Town Hall, 53095 Main Road
®�' �- ��� P.O. Box 1179
Q( ` ,4 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. 1092-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner HUBBARD, JAMES AND RUTH
Mailing Address 1 P. O. BOX 226
Mailing Address 2
City St Zip PECONIC NY 11958-0000
Property Address 1 226 CARROLL AVENUE
Property Address 2
City St Zip PECONIC NY 11958-0000
Owner Telephone No. 516-765-1272
Tax Map No. section 74.00 block 3 lot 21 .000
Cross Street COUNTY ROAD 48
Date Of Last Pump Out 0/00/00
Issue Date: 4/27/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK cvFFDL'
Town of Southold �% :.• ea -- Application No. 10 92_-
Judith T. Terry, Town Clerk �� , 4-'r �4 y
Town Hall, 53095 Main Road r�. --"'° :4 l Residential
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P. O. Box 1179 cn � esve.t �;. � Non-Residential
Southold, New York 11971 0 �__ ---f-0
Telephone j )0".
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /6 ' _ .
DATE 'y ea 7/ ��
OWNER NAME: di/TIES 4- kb,-4-) i`'1(-f.b La )
OWNER MAILING ADDRESS: E &')� q�a(e Oar-14/c2/2cce--
eC )fliC. 1) l 1/19 S-
OWNER PROPERTY ADDRESS: (g Ca_r�Ol e,nue__-., — _`
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OWNER TELEPHONE NUMBER: (e10 '7b /at-7a-
TAX MAP NO. : Section 7q Block 3 Lot o2/
CROSS STREET: C1( a4 .2.76?
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing 4‘
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.)
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Signature of Applicant
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RECEIVED BY: LC)/4(A,____--i
own Clerk's Office
DATE: gig/
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