HomeMy WebLinkAboutSkabry 4; 4 If94--
JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK ® r� P.O. Box 1179
REGISTRAR OF VITAL STATISTICStri Southold, New York 11971
MARRIAGE OFFICER ® ®�
� Fax (516) 765-1823
Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 2076-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner SKABRY, JOHN
Mailing Address 1 390 HENRY'S LANE -
Mailing Address 2
City St Zip PECON I C NY 11958-0000
Property Address 1 390 HENRY' LANE
Property Address 2
City St Zip PECON I C NY 11958-0000
Owner Telephone No. 516-734-6786
Tax Map No. section 74.00 block 2 lot 34.000
Cross Street ROUTE 48
Date Of Last Pump Out 0/00/00
Issue Date: 3/10/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK �FFO� " $
Town of Southold �� CQG Application No.gO'
Judith T. Terry, Town Clerk :'`thy _ `' $10.00 - Residential
Town Hall, 53095 Main Road n ,<
P. O. Box 1179 crs . . : � $25.00 - Non-Residential
Southold, New York 11971
.,.
Telephone -_*Qi t •
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
1
Operation Permit No.
Fee $ ---'
DATE 3 - 6 -
OWNER NAME: JPO //gI JkirMey
OWNER MAILING ADDRESS: j9(9 ///Uielf a
P6 UM c 111
OWNER PROPERTY ADDRESS: J/(f
OWNER TELEPHONE NUMBER: ,' V- 6 1al.
TAX MAP NO. : Section -71 Block Lot 3 ,1
CROSS STREET: / $GP.
TY.P E; OE_ SYSTEM: Septic Tank New Existing
Cesspool New Existing c�
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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.)
41
g vture of Applicant
RECEIVED• BY:
Town Clerk's Office
DATE:
•
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