HomeMy WebLinkAboutReybine 011.41VULKO %
; , . Town Hall, 53095 Main Road
P.O. Box 1179
_ �'�' Southold, New York 11971
JUDITH T.TERRY `� !! 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. 787-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner REYBINE, LAWRENCE
Mailing Address 1 P. O. BOX 796
Mailing Address 2
City St Zip ORIENT NY 11957-0000
Property Address 1 PETES HILL ROAD
Property Address 2
City St Zip ORIENT NY 11957-0000
Owner Telephone No. 516-323-2533
Tax Map No. section 17 . 00 block 4 lot 23 . 000
Cross Street YOUNGS ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 8/15/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK c \VFair -
Town of Southold 0 {;. :� Application No. -It/
Judith T. Terry, Town Clerk r : y
Town Hall, 53095 Main Road ger „ ,ea Residential
P. O. Box 1179 cnt �� Non-Residential
Southold, New York 11971 ® 1:*.
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Telephone Q( ym `��� '��
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE /906-- /1/, qd
OWNER NAME: zifei y4 ( AKK
OWNER MAILING ADDRESS: Al=� L fr L ,-10e/9-12° gox '/ 4
WI,efther ,_y'•
OWNER PROPERTY ADDRESS: YaiE
OWNER TELEPHONE NUMBER: .674 c2 3 c; -6' r'
TAX MAP NO. : Section /7 Block ,q Lot ).., •
CROSS STREET: `, F5'f OP ("ate/64/.117 44A/4- Yo'ri/eAcs/44?7
TYPE OF SYSTEM: Septic Tank New Existing /
Cesspool it/ Existing
Y
Residential Y Non-Residential
DATE OF PREVIOUS PUMP-OUT:
kr 4 (96
LO ION MAP: Must be attached hereto before permit may be issued.
f (Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
o
41110
31O Signature o pi.licant
RECEIVED BY: Get, c,-
Town (Titerk Office
DATE:
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