HomeMy WebLinkAboutPerkins ,�_ "OW
�� Town Hall, 53095 Main Road
P.O. Box 1179
`A�9 0���� Southold, New York 11971
JUDITH T. TERRY '����� 1111°°1
TELEPHONE
TOWN CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1099-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner PERKINS, DAVID
Mailing Address 1 KING STREET
Mailing Address 2
City St Zip ORIENT NY 11957-0000
Property Address 1 KING STREET
Property Address 2
City St Zip ORIENT NY 11957-0000
Owner Telephone No. 516-323-3604
Tax Map No. section 26.00 block 2 lot 35.000
Cross Street PRIVATE ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 5/08/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK m•
S‘FFD(L,��'
Town of Southold , ��Q C'0A'- Application No. /O P 9
Judith T. Terry, Town Clerk =r �r :1 Residential
Town Hall, 53095 Main Road a
P. O. Box 1179 v' 3' r ; Non-Residential
Southold, New York 11971 ..rO� ��`
Telephone �j 0) '/
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. /6 79
Fee $ , • -- - . _ _. .
DATE 4rhhf ,qt?
• OWNER, NAME: hAvi. PC-1/2`�oUs
OWNER MAILING" ADDRESS: O0€(fr) ivy
OWNER PROPERTY ADDRESS:/, tb6
OP(e JT IV`/
OWNER TELEPHONE NUMBER: 32.3— 36a 4--
TAX MAP NO. : Section 26 Block Z Lot 35
CROSS STREET: PRIVA'rf Rh .
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ✓ New Existing
Residential ✓ Non-Residential
•
DATE OF PREVIOUS PUMP-OUT:XI, P(Qvj®1.0 / ("3/1140
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.)
9f0f-•// ,t-
Sign ture of A plicant
RECEIVED BY:
Town tlerk' ce
DATE:
MAY Y ®-8 •
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