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W )` 1 Town Hall, 53095 Main Road
" ��` P.O. Box 1179
��0"! Southold, New York 11971
JUDITH T.TERRY . -
e, TELEPHONE
TOWN CLERK �'"iccLN�� (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. 815-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner MANDEL, HERBERT R.
Mailing Address 1 P. O. BOX 130
Mailing Address 2
City St Zip GREENPORT NY 11944-0000
Property Address 1 265 ORCHARD STREET
Property Address 2
City St Zip ORIENT NY 11935-0000
Owner Telephone No. 516-477-2223
Tax Map No. section 25. 00 block 2 lot 11. 000
Cross Street VILLAGE LANE
Date Of Last Pump Out 0/00/00
Issue Date: 9/06/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
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OFFICE OF THE TOWN CLERK c,VFFULt°°-
Town of Southold
CD ; Application No. ?/c5—
Judith T. Terry, Town Clerk Y
Town Hall, 53095 Main Road ` �' s z :� 1 Residential
P. O. Box 1179 'WV
xY r77
� � �, � � ` Non-Residential
Southold, New York 11971 O4");'- ' -0/�
Telephone : It
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
•
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. -
' _ •Fee. $, ; .. `. -. f, ,, - • . - -- .. - - -- •- - - _ _
DATE
OWNER NAME: lfeA6e/t R• Mandel
OWNER MAILING ADDRESS: P. 0. Bax 130, Gneenpo/tt, N. V. 179.44
OWNER PROPERTY ADDRESS: 265 UncJcand Skeet
()taut, N. V. 71957
OWNER TELEPHONE NUMBER: 1516) 477-2223
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TAX MAP NO. : Section 25 Block 2 Lot 11
CROSS STREET: Mew Lave, U}uewt
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool Y. New Existing X
Residential x ' Non-Residential
DATE OF PREVIOUS PUMP-OUT: 7
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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RECEIVED BY: .
Town Clerk's Office
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engineering p.c.
STREET 0 west main street
a riverhead, new york 11901
.F (516) 369 - 1717
~ • July 3, 1986 Job N2 86-1308
AREA 37,653sq ft (08644ac) ,' 1000-025-02-II Scale: I" = 40'
RWDir. f