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OFFICE OF THE TOWN CLERK �FF14l'
Town of Southold �� ; QG
Judith T. Terry, Town Clerk 4 s �
Town Hall, 53095 Main Road
P. ,O. Box 1179 ;u' = ,,fz
Southold, New York 11971 ;Oft 4'
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Telephone _ ,(
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. NR 15 Residential
Non-Residential xx
'Fee $ 25.00
Septic Cesspool xx
NAME OF OWNER: MGH Enterprises Inc. d/b/a Orient-by-the-Sea Marina
OWNER MAILING ADDRESS: P.O. Box 333
Orient, New York 11957
OWNER PROPERTY ADDRESS: Main Road
Orient, New York
OWNER TELEPHONE NUMBER: 516a-323-2424
TAX MAP NO. : Section 15 Block 9 Lot 8
CROSS STREET: Land's End Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool xx New Existing xx
Residential Non-Residential xx
DATE OF PREVIOUS PUMP-OUT: Unknown
Judith T. Ter
Southold Town Clerk
DATE: October 1, 1986
(TOWN SEAL)
OFFICE OF THE TOWN CLERK c0FD(.,Y��'
Town of Southoldt� = CQ 5
Application No./V/ i
Judith T. Terry, Town Clerk `` , 4:�
Town Hall, 53095 Main Road :'� ' Residential
P. O. Box 1179 cn
,. � Non-Residential ?�
Southold, New York 11971 O
Telephone
(516) 765-1801 fig
TOWN OF SOUTHOLD
RECER"�€")
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OCT
OCT 01
To!Am 4'litrk ' . F APPLICATION '
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4YX A$
Fee $ q7S S-*
DATE
OWNER NAME: fr 7L-VeP1t-1 5 /0C
OWNER MAILING ADDRESS: 3D y 3 3
0
OWNER PROPERTY ADDRESS: P-1A-/N Ve. S
OWNER TELEPHONE NUMBER: <574 -3 ,23 -d-ya
TAX MAP NO. : Section Block /" Lot 8"
41.A//D's (ens 7' c )
CROSS STREET: ir/e X 7 -v /-7 cd— ld 01zn( S rf4kJ;
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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.)
► =
Sign.) re .f Applicant
RECEIVED BY: G�
Town Cd(erk's Office
DATE: / , / PPG
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