HomeMy WebLinkAboutHubbard (4) 44,
m Town Hall, 53095 Main Road
t�` P.O. Box 1179
., Southold, New York 11971
JUDITH T.TERRY ----IV./
"% .., Southold,
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. 821-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner HUBBARD, LESTER
Mailing Address 1 ALBO DRIVE
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 ALBO DRIVE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-4584
Tax Map No. section 126. 00 block 3 lot 19. 000
Cross Street WELLS ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 9/09/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK cl.FFO(,r^
Town of Southold w`OG Application No. gcP4/
Judith T. Terry, Town Clerk ,. w��
Town Hall, 53095 Main Road a "',� K , < 1 Residential
x
P. O. Box 1179 cny Non-Residential
Southold, New York 11971 O � 4' �O`���`
Telephone `�
(516) 765-1801 ,,,
TOWN OF SOUTHOLD
REM'. h
SE? 07 488 SOUTHOLD WASTEWATER DISPOSAL DISTRICT
Tan clog
APPLICATION
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OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. �, 2-
Fee $ /Di
DATE 5�,2/ //7/8g
8
/ /
7
OWNER NAME: 4� / lid /pa
OWNER MAILING ADDRESS: fl‘/3 ) Di/ Y''
OWNER PROPERTY ADDRESS: 54-4
OWNER TELEPHONE NUMBER: �,9 LISTL`
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TAX MAP NO. : Section /� L Block 3 Lot
CROSS STREET: LA) OM 6P---4
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
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.)
Signi re of Applicant
RECEIVED BY:
RECEIVIremn Clerk's Office
DATE: SF P 1buti
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