HomeMy WebLinkAboutKings Bay OFFICE OF THE TOWN CLERK •c.AFIll
Town of Southold o ,��
Judith T. Terry, Town Clerk ,� II 4
Town Hall, 53095 Main Road c 0.00
, Y �'
P. 0. Box 1179 v' Or"
Southold, New York 11971 Q ® v
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 363 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool X
NAME OF OWNER : Kings Bay Partnership (Matthew McCaslin)
OWNER MAILING ADDRESS: P.O. Box 1721
Southold, New York 11971
OWNER PROPERTY ADDRESS: ROW off King Street
Orient, New York
OWNER TELEPHONE NUMBER: 516-765-5847 or 1212
- TAX MAP NO. : Section 27 Block 3 Lot p/o 4
CROSS STREET: King Street
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New X Existing
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: N/A
Judith T. Terry
Southold Town Clerk
DATE: July 29, 1987
(TOWN SEAL)
fr
.2 o0
n J
// I/I
OFFICE OF THE TOWN CLERK ����F�U.�'=
Town of Southold _o , ,.. CQG Application No. 3623 -_
Judith T. Terry, Town Clerk , _
Town Hall, 53095 Main Road ' , :'( Residential V
P. O. Box 1179 to f ;. Mi z Non-Residential
.
Southold, New York 11971 P r , - .$
Telephone #59e.(
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. _ ,
Fee $ J _ D O
DATE tel, )I,/ / 7-o 1c7W37
/ rlb5-s ?'-f
OWNER NAME: ' .
OWNER MAILING ADDRESS: zb50 --5A'-ijP ' , ! —0°, \72.,
)01--1-4 0 L J J\;Ni . \-. 1-7
OWNER PROPERTY ADDRESS: 3\Kr07-k\-1- - \°-C.\,'t:v):6-7--Sk -C-V-7-
Cil'-\'e=:'- -/-\r/
\-I.
OWNER TELEPHONE NUMBER: b\L- 7(p — 5% 91 61Z,12
TAX MAP NO. : Section Z7 Block Lot p/0 9
CROSS STREET: \< \ re.... ..
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool >4 New X Existing
Residential ix Non-Residential
DATE OF PREVIOUS PUMP-OUT: A///?'
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.)
6
n
11
ignat r- of Ap•
icant
p
RECEIVED BY: 04 /Avg
To n ¶ ler"s Of ice
DATE: 7/2 /7