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JUDITH T. TERRY �� Town Hall, 53095 Main Road
TOWN CLERK Z P.O. Box 1179
REGISTRAR OF VITAL STATISTICS T ; Southold, New York 11971
MARRIAGE OFFICER �'�`� Fax ( 16) 765-1823
��®' �•,0�� Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1694-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
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New Existing X
Name Of Owner GARBE, GEORGE
Mailing Address 1 P. O. BOX 219
Mailing Address 2
City St Zip EAST MARION NY 11939-0000
Property Address 1 685 OSPREY NEST ROAD
Property Address 2
City St Zip EAST MARION NY 11939-0000
Owner Telephone No. 516-477-2061
Tax Map No. section 35.00 block 6 lot 27.000
Cross Street MAPLE LANE
Date Of Last Pump Out 0/00/00
Issue Date: 5/22/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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^OFFICE OF THE TOWN CLERK scOFU1j- • i ��
Town of Southold �� _.- Q... Application No. Cd
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road c .0 I $10.00 - Residential
P. O. Box 1179 u' -=ti 115.17V : $25.00 - Non-Residential
Southold, New York 11971 O ®
Telephone 0.. • •••
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE ?w,(41---17 /erq(
OWNER NAME: ���C 6b
OWNER MAILING ADDRESS: O. 3QX Zl
� S (Ou( �v }� f/9'5?
OWNER PROPERTY ADDRESS:
&SrA,'(ACQVt ,v y ( (9'5
OWNER TELEPHONE NUMBER: (574) 4-77 -2-00
TAX MAP NO. : Section 35 Block b Lot ?r7
CROSS STREET: jU t--t
TYPE OF SYSTEM: Septic Tank 01(67 New Existing ( c[CE 1q l
Cesspool 77AJ0 New Existing t( i°
Residential Y Non-Residential
DATE OF PREVIOUS PUMP-OUT: 74P L 4- ( (Q9/
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.)
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Signat re f Applicant
RECEIVED BY:
Town C rk's Otfrce
DATE:
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