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HomeMy WebLinkAboutSabat (2) OLK r Town Hall, 53095 Main Road v'o ny �� P.O. Box 1179 /�l ���.6' Southold, New York 11971 JUDITH T.TERRYTELEPHONE TOWN CLERK (516) 765-1801 REGISTRAR 01 VITAL STATISTICS OFFICE OF THE TOWN CLERK_ TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 638-R Residential X Non-Residential Fee $ 10. 00 Septic Cesspool X New Existing X Name Of Owner SABAT, WALTER Mailing Address 1 5980 SOUND AVENUE Mailing Address 2 City St Zip MATTITUCK NY 11952-0000 Property Address 1 5980 SOUND AVENUE Property Address 2 City St Zip MATTITUCK NY 11952-0000 Owner Telephone No. 516-298-8163 Tax Map No. section 121. 00 block 4 lot 4.000 Cross Street COX NECK ROAD Date Of Last Pump Out 0/00/00 Issue Date: 3/07/88 Judith T. Terry Southold Town Clerk (TOWN SEAL) • w"- ,f • �i OFFICE OF THE TOWN CLERK cSFU(� Town of Southold %� r- Application Noy Judith T. Terry, Town Clerk . 'a Residential �`} Town Hall, 53095 Main Road ' P. O. Box 1179 7v Non-Residential Southold, New York 11971 D Qi*t"t`�`0 •�` Telephone i � (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No.6.3 4, Fee $ /CI DATE OWNER NAME: 1.A.) ALA-1.L. Q, JA bAT OWNER MAILING ADDRESS: 5(42,® — irn 9s-a. OWNER PROPERTY ADDRESS: S.A6nt. AS OWNER TELEPHONE NUMBER: E.i.(a -` CfS- S 'f6 TAX MAP NO. : Section \ a,� Block 4 Lot CROSS STREET: Com 11`��LCIL lel TYPE OF SYSTEM: Septic Tank New Existing Cesspool New Existing Residential Non-Residential DATE OF PREVIOUS PUMP-OUT: 7 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.) Signature of Applicant RECEIVED BY: L�¢2 Town Jerk's ffice DATE: 3/ /fl 41 - cj fo�S r- © 15-1 _ - -- -- -- -fin -