HomeMy WebLinkAboutHubbard JUDITH T. TERRY ; .. Town Hall, 53095 Main Road
TOWN CLERK Z • P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER 000,04
y Fax (516) 765-1823
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(516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1771-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner HUBBARD, ROBERT
Mailing Address 1 16300 MIDDLE ROAD
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 163900 MIDDLE ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-6294
Tax Map No. section 101 .00 block 2 lot 11 .001
Cross Street ALVAH'S LANE
Date Of Last Pump Out 0/00/88
Issue Date: 9/26/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
I..
OFFICE OF THE TOWN CLERK IC.31FO(,r.'.
Town of Southold Application No. /2 7/
Judith T. Terry, Town Clerk •� 3`'" ,� i�
Town Hall, 53095 Main Road � ..0 $10.00 - Residential
P. O. Box 1179 cry ,5 •
$25.00 - Non-Residential
Southold, New York 11971ho y` 6'
Telephone
•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE / /97
OWNER NAME: moi, ,;ice
OWNER MAILING ADDRESS: /(Q 30 G h Cy
•
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: 2 3 7 0
TAX MAP NO. : Section /O / Block Lot /1 ., /
CROSS STREET: .
TYPE OF SYSTEM: Septic Tank N w 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.)
Signature of Applicant
RECEIVED BY:
. � -1
.wn Clerk's Office
DATE: 9 g-C, / L/
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