HomeMy WebLinkAboutLebanon I
WI Town Hall, 53095 Main Road
`0 ;'. P.O. Box 1179
1 `� �t.,1'6 Southold, New York 11971
JUDITH T.TERRY -% ,,ir17/0- FAX(516)765-1823
TOWN CLERK TELEPHONE(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. 113-N Residential Non-Residential X
Fee $ 25.00 Septic Cesspool X
New Existing X
Name Of Owner LEBANON CHEMICAL CORP
Mailing Address 1 LESSEE - I. M. YOUNG 8 CO. INC
Mailing Address 2 BOX 216
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 DEPOT LANE
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-6452
Tax Map No. section 96.00 block 2 lot 3.000
Cross Street ROUTE 48
Date Of Last Pump Out 0/00/00
Issue Date: 10/02/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
• •..
OFFICE OF THE TOWN CLERK •SJFFO(//' - //0
Town of Southold % Application No.
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Judith T. Terry, Town Clerk 4 `+� $10.00 - Residential
Town Hall, 53095 Main Road
P. O. Box 1179 $25.00 - Non-Residential �-
Southold, New York 11971 O ' , :> •�`�
Telephone
(516) 765-1801 -
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
„
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL -
Operation Permit No.
Fee $ •
DATE
'OWNER NAME: L61rJo ) G ig-. /e./95. /rte aclit9�e-F�,/,�.
47,E •A ER MAILING ADDRESS: 3S( ,b- C�
S'Oc.,771cs ,otilyr !(97/
OWNER PROPERTY ADDRESS: crjresPD7 _
OWNER TELEPHONE NUMBER: 6-- 7254,-6 f-2
TAX MAP NO. : Section Block Lot
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool / New Existing !/
Residential Non-Residential IS
DATE OF PREVIOUS PUMP-OUT: / 19 ell
-
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.)- '
Off / _41Y •" et. /Gll era*d-e*
Signature of •Aplicant
RECEIVED' BY': 4,c , �C � rJ
Town Clerk's'Office
DATE:
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