HomeMy WebLinkAboutRegensOFFICE OF THE TOWN CLERK
Town of Southold
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road
P. 0. Box 1179
Southold, New York 11971
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 56
Fee $ 10.00
Residential XX
Non -Residential
Septic Cesspool Xx
NAME OF OWNER: Regens International Corp.
OWNER MAILING ADDRESS: P.O. Box K, North Road
Greenport, New York 11944
OWNER --PROPERTY -ADDR-ESS-: - Ui l-lage -Lane .-(:Bay -House-Cottage, Apts A
Orient, New York
OWNER TELEPHONE NUMBER: 516-477-1832
TAX MAP NO.: Section 24
Block
CROSS STREET: West Bay Avenue
TYPE OF SYSTEM: Septic Tank
Cesspool
New
XX New
Residential XX
2
Lot 27
Existing
Existing XX
Non -Residential
DATE OF PREVIOUS PUMP -OUT: October 1984
DATE: September 22--1R&6—
(TOWN
2 1986
.,,.—�
Judith T. Tertq
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK
Town of Southold
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road
P. 0. Box 1179
Southold, New York 11971
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Application No:� /('"'
Residential
Non -Residential
Operation Permit Nos.`451
Fee $ ID - D
DATE di
OWNER NAME: f >-6 L-�lV S I 'k I?A
OWNER MAILING ADDRESS: 1( 0'V4 kaz/ P 6 , hlfi j(
2t
OWNER PROPERTY ADDRESS:
D�
l—/�� _
OWNER TELEPHONE -NUMBER: r,%-1 Z 77 l� z
TAX MAP NO.: Section q! Block Lot C1,27
CROSS STREET: Zaetg 7`' �4 4--7�-P_
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential
DATE OF PREVIOUS PUMP -OUT:
Non -Residential
16a-_ /4S,
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.)
Sig ature of Applicant
RECEIVED BY:
Town erk's Offfice
DATE: VA Y/yds
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