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1
JUDI T. TERRY
JUDITH acs'
10WN CLERK
REGISTRAR 01' VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No
Fee $ 10.00
Name Of Owner
Mailing Address 1
Mailing Address 2
City St Zip
Property Address 1
Property Address 2
City St Zip
Owner Telephone No.
Tax Map No. section
Cross Street
Date Of Last Pump Out
Issue Date: 9/15/88
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
TELEPHONE
(516) 765-1801
834-R Residential X Non -Residential
Septic Cesspool X
New Existing X
703 FLINT STREET ASSOCIATES
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C/O MARCAR MANAGEMENT COMPANY
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P. 0. sox 297
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GREENPORT NY 11944-0000
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703 FLINT STREET
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GREENPORT NY 11944-0000
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516-477-2851
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48.00 block 2 lot 20.000
SEVENTH STREET
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0/00/00
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Judith T. Terry
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
,own for
�i gh 5outhole
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee S
App lication Noj 3
Residential
Non -Residential
DATE1 7—
OWNER NAME: 703 rLIat Sftee f A56C//f/e s
OWNER MAILING ADDRESS: U2C'A-•i2 Ati,46eR/
a AO Y, 6ace'..."491 , tri-
OWNER PROPERTY ADDRESS: 7o3 FG/HJt St f
OWNER TELEPHONE NUMBER:
a
TAX MAP NO.: Section z } Block DoZ Lot 0A0
CROSS STREET: % �' &"r '
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool _N ew Existing
Residential ✓ Non -Residential
DATE OF PREVIOUS PUMP -OUT: A06 . / 1rJ--V
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.)
f '
Signature of Applicant
RECEIVED BY:
RENwC Jerk's Office
Town otet 500016
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a ce sS odL s
2
4 30
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of house
2. /Y' wp-sf of max.