HomeMy WebLinkAboutGabriel OFFICE OF THE TOWN CLERK • c�FF_Q �,7
Town of Southold4
Judith_T. Terry, Town Clerk
Town Hall, 53095 Main Road
P. 0. Box 1179
Southold, New York 11971 ;Q _ �
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Telephone __ �[
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 271 Residential
Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: George Gabriel
OWNER MAILING ADDRESS: RD 1 , Box 139A
Mattituck, New York 11952
OWNER PROPERTY ADDRESS: 1220 Youngs Avenue
Southold, New YOrk
OWNER TELEPHONE NUMBER: 516-298-5103
TAX MAP NO. : Section 60 Block 2 Lot80
CROSS STREET: Main Road
TYPE OF SYSTEM: Septic Tank New Exis}ing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
LOT
Judith T. Terry'
Southold Town Clerk
DATE: April 13, 1987
' (TOWN SEAL; -
•0
OFFICE OF THE TOWN CLERK \FFA '
Town of Southold �� ljG',, Application No. a7(
Judith T. Terry, Town Clerk �►''
Town Hall, 53095 Main Road f ` �`� Residential
P. O. Box 1179cry Non-Residential
Southold, New York 11971 O �.
Telephone ;YE
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE VP/i7
OWNER NAME: GeV CE,PE
OWNER MAILING ADDRESS: Pb / J 0 )4. i X91"
a i 171J c K L 9
OWNER PROPERTY ADDRESS: / Z2,6 U ALB s -UE-
Sou t ten,C.-o y t /Q7/
OWNER TELEPHONE NUMBER: 2-9 - c7 o 3
TAX MAP NO. : Section U 6 Block Lot
CROSS STREET: YOU A.J •( c A-11 r< A- A(iv 12-
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ✓ New Existing
Residential i/ 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.)
06kil(A •
Sig ture of pplicant
RECEIVED BY:
Town Clerk's Office E(}PN�
DATE: G seo - �«
7-41'
400- ito-10)
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Nogil-i- Youif, 6' ALS