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'1 cr5 ' ' : Town Hall, 53095 Main Road
�O /�� P.O. Box 1179
-----.:7970/ $'0.01 Southold, New York 11971
JUDITH T.TERRY ���� TELEPHONE
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'[OWN CLERIC (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. 653-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New X Existing
Name Of Owner STARKIE, GEORGE
Mailing Address 1 29 WALNUT STREET
Mailing Address 2
City St Zip SMITHTOWN NY 11787-0000
Property Address 1 630 TARPON DRIVE
Property Address 2
City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 516-360-0589
Tax Map No. section 57. 00 block 1 lot 7. 000
Cross Street MAIN ROAD
Date Of Last Pump Out 0/00/00
45/
Issue Date: 3/16/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK oFQU. �?,
Town of Southold �� 4. Application No.('
Judith T. Terry, Town Clerk Residential z.7Town Hall, 53095 Main Road
t °1 ;..
P. O. Box 1179 cry ,- f ,r �` Non-Residential
u� _. sir;- <� �
Southold, New York 11971 O' ' "
Telephone _"�.( Y►�
(516) 765-1801 _
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
- for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE /1-7/92 /?) /5'86
OWNER NAME:
OWNER MAILING ADDRESS: 2 9 64/r9CA./c/7- 7/d6,----
A/ y, //7g7
OWNER PROPERTY ADDRESS: C 30 x.9.2,40%J 27,2///
7.24.-&--7--/,'°€7;
OWNER TELEPHONE NUMBER: (576) 3o- 95c9
TAX MAP NO. : Section 057 Block 0/ Lot 07
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New V Existing
Cesspool New Existing
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.)
Si nature of Applicant
RECEIVED BY: -
Town Clerk's Office .
DATE:
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