HomeMy WebLinkAboutLim OFFICE OF THE TOWN CLERK • •�U,i'UUr��G
Town of Southold DV ,,
Judith T. Terry, Town Clerk ,
Town Hall, 53095 Main Road k = 4-m
P. O. Box 1179 •:v'
Southold, New York 11971 Q ®, = �- •�
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Telephone v./ ift P�O
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 130 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: Mokai Lim
OWNER MAILING ADDRESS: 600 East Legion Avenue
Mattituck; New York 11952
OWNER PROPERTY ADDRESS: 600 East Legion Avenue
Mattituck, New York
OWNER TELEPHONE NUMBER: 516-298-8451
TAX MAP NO. : Section 143 Block 4 Lot 1i
CROSS STREET: Bay Avenue
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool x New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: September 1986
Judith T. Terry
Southold Town Clerk
DATE: November 7, 1986
(TOWN SEAL) -
OFFI(F��OF THE TOWN CLERK
T
own of Southold CDG'; Application No. /3
Judith T. Terry, Town Clerk ���; ter ,
Town Hall, 53095 Main Road Residential
P. O. Box 1179 cry { i�`' Non-Residential
Southold, New York 11971 OO ., r. O' ��`
Telephone .( '/
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for.
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. /30
Fee $ /
DATE 11,67—igl
OWNER NAME: M 0 14- ( L I n1
OWNER MAILING ADDRESS: 600 6 4/ P..
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: � 8 " S'¢' C
TAX MAP NO. : Section 114'a `1 ' 'Block 43. Lot
CROSS STREET: Itety e
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing <<�
Residential ✓ Non-Residential
DATE OF PREVIOUS PUMP-OUT: t ' --- L°L
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.)
Ad) 42„..,2.
Signature of Applicant
RECEIVED BY: CirccC.�_
Town erk's fice
DATE:
RECEIVED
NOV 07
Town Clerk Southold
FROM-THE DESK OF: •,
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MOKAI LIM
600 EAST LEGION AVE.
MATTITUCK, N.Y. 11952