Loading...
HomeMy WebLinkAboutGabel 1 = Town Hall, 53095 Main Road �® �r P.O. Box 1179 __- I®0�� Southold, New York 11971 JUDITH T.TERRY ---w,osi TELEPHONE TOWN CLERK (516) 765-1801 REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK TOWN OF 3OUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 663-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner GABEL, THEODORE F. Mailing Address 1 P.O. BOX 71 MAIN ROAD City St Zip EAST MARION NY 11939-0000 Property Address 1 MAIN ROAD City St Zip EAST MARION NY 11939-0000 Owner Telephone No. 516-477-0194 Tax Map No. section 31.00 block 5 lot 4. 000 Cross Street STARS ROAD Date Of Last Pump Out 0/00/00 Issue Date: 3/30/88 Judith T. Terry Southold Town Clerk (TOWN SEAL) OFFICE OF THE TOWN CLERK S�FF7j .�' - Town of Southold = ��� Q ' Application No. Judith T. Terry, Town Clerk �.° Town Hall, 53095 Main Road a ; Residential P. O. Box 1179 v' * z „ Non-Residential Southold, New York 11971 O Oy��' Telephone 0 %g • (516) 7'65-1801 TOWN OF SOUTHOLD • SOUTHOLD WASTEWATER DISPOSAL DISTRICT • • 'APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ DATE .2/r -2/0' S -scp • • OWNER NAME: gopme OWNER MAILING ADDRESS: 4,i, ©4.,0 %D 7/ fl,g/,/oti A/f . 1,161 3 OWNER PROPERTY ADDRESS: ,;� /-/ . R4-51- /-/ ,&/O' OWNER'TELEPHONE NUMBER: Cr) !o Lf• 7 7 O f Cf TAX MAP NO. : Section 3Block g Lot I - CROSS STREET: TYPE OF SYSTEM: Septic Tank New Existing Cesspool New - Existing Residential g 'f Non-Residential DATE OF PREVIOUS PUMP-OUT: , 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.) Signa ure of Applic t • RECEIVED BY: Town Clerk's Office DATE: 50 --� 0 /e/ F►vj