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JUDITH T.TERRY Town Hall,53095 Main Road
TOWN CLERK ` °`' a ; P.O.Box 1179
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k '1 Southold,New York 11971
REGISTRAR OF VITAL STATISTICS �£=',s / Fax(516)765-1823
MARRIAGE OFFICER � ® 11
9/1 . •�I Telephone(516)765-1800
RECORDS MANAGEMENT OFFICER � � � i
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3423-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner ROBBINS, YOLANDA
Mailing Address 1 1200 DEEPHOLE DRIVE
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 1200 DEEPHOLE DRIVE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-8351
Tax Map No. section 115.00 block 12 lot 16.000
Cross Street NEW SUFFOLK AVENUE
Issue Date: 1/05/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFICE OF THE TOWN CLERK COFair
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Town of Southold N� CQG,� Application No.3,.L3
Judith T. Terry, Town Clerk „ . *%".
Town Hall, 53095 Main Road a -� $10.00 - Residential
P. 0. Box 1179 to • ;' $25.00 - Non-Residential
Southold, New York 11971O0;/
{1' REcEWED
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Telephone el
(516) 765-1801 �„ ! ?° 11-9.3
TOWN OF SOUTHOLD ithin % •
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
•
APPLICATION
for
OPERAT ION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE 12/11/95
OWNER NAME: Yolanda Robbins
OWNER MAILING ADDRESS: 1200 Deephole Drive
Mattituck, New York 11952
- OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: (516) 298-8351
TAX MAP NO. : Section i i 5 Block 12 Lot 16
CROSS STREET: New Suffolk
TYPE-OF'SYSTEM: Septic Tank ---New Existing
Cesspool New Existing X
Residential X Non-Residential
LOCATION MAP: Must be attached hereto before permit may be issued. (:
(Locate building and system; give north arrow and feet O�e�
of distance, approximately, to building and closest road.)
Signature•
•
o Applicant
RECEIVED`BY: --
Town Clerk's Office
•
DATE:
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