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01 OZOO^SIL (��
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� '��� P.O. Box 1179
AA, � � 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. 871-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner STARON, MICHAEL T. AND WIFE
Mailing Address 1 1210 VILLAGE LANE
Mailing Address 2
City St Zip ORIENT NY 11957-0000
Property Address 1 1210 VILLAGE LANE
Property Address 2
City St Zip ORIENT NY 11957-0000
Owner Telephone No. 000-000-0000
Tax Map No. section 25. 00 block 1 lot 24. 000
Cross Street SKIPPERS LANE
Date Of Last Pump Out 0/00/00
Issue Date: 10/03/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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