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Town Hall, 53095 1�Iain Road
�® � '�` P.O. Box 1179
__- ®� lit 1�, .0. Southold, New York 11971
JUDITH T.TERRY _����ii�i�••l 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. 738-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner MARKEL, WILLIAM M.
Mailing Address 1 850 LUPTONS POINT
Mailing Address 2
City St Zip MATTITUCK, NY 11952-0000
Property Address 1 850 LUPTONS POINT
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-8138
Tax Map No. section 115. 00 block 11 lot 15.000
Cross Street MARRATOOKA ROAD
Date Of Last Pump Out 7/24/82
Issue Date: 6/23/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK OFDUr•'
Town of Southold , 0�0 i,. Application No.
Judith T. Terry, Town Clerk .: '�: y
Town Hall, 53095 Main Road rr � Residential
P. O. Box 1179L04 ..r ' M rte:,*:- Non-Residential
Southold, New York 11971 O
Telephone Q(44—
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
ti; 11-1 I 'zt&
DATE
OWNER NAME: tf) '!_L 1 4 N '
OWNER MAILING ADDRESS: S'19 111-11:-----
OWNER
114OWNER PROPERTY ADDRESS: S'/O 1-- 1.1?-1 0' ( i 1
IV) i i L I. v �7< 1ti
OWNER TELEPHONE NUMBER: 4 cis-
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TAX MAP NO. : Section / ) .5 d Block / 0 Lot
CROSS STREET: A R.a (A-`r 0 k Rio'
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing e/
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: ) 1
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 11,3X.,:„, G .r �C�.a,
R Town Clerks Offic
DATE: ,4'irk A 31989
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