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Home My WebLink AboutMoy �• Town Hall, 53095 Main Road cf2P.O. Box 1179 Southold, New York 11971 JUDITH T.TERRY FAX(516)765-1823 TOWN CLERK TELEPHONE(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. 1210-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner MOY, YORK P. AND MOY M. Mailing Address 1 3 PONDEROSA DRIVE Mailing Address 2 City St Zip MELVILLE NY 11747-0000 Property Address 1 2700 VANSTON ROAD Property Address 2 City St Zip CUTCHOGUE NY 11935-0000 Owner Telephone No. 516-367-4602 Tax Map No. section 111 .00 block 5 lot 4.000 Cross Street OLD COVE ROAD Date Of Last Pump Out 0/00/00 Issue Date: 8/08/89 Judith T. Terry Southold Town Clerk (TOWN SEAL) OFFICE OF THE TOWN CLERK- ,`r Town of Southold Application No. /WO Judith T. Terry, Town Clerk � ` $10.00 - Residential Town Hall, 53095 Main Road 1� P. O. Box 1179 v' tt''` • • $25.00 - Non-Residential Southold, New York 11971 O ® `?' O�'��` Telephone _®j 00, (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICAT ION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ /f' (o-7) DATE 41,f0 Gr/1(527 OWNER NAME: / my /-0x H. Hoy • • OWNER MAILING ADDRESS: 3 p©,) p....05,9 frioz- Vi L L N y / 7447 OWNER PROPERTY ADDRESS: 270c:9 J/i9A.)5704/ fa - e rWWvquz-) A- OWNER TELEPHONE NUMBER: .-5V, 367- 116,02i TAX MAP NO. : Section // / Block j Lot /IL CROSS STREET: /d, c,/, TYPE OF SYSTEM: Septic Tank New Existing Cesspool v New Existing V Residential Non-Residential DATE OF PREVIOUS PUMP-OUT: /"fid \, 1 5-1 Jq ! 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.) 5 )_oc Tr o yJ of C ?IF �� ''e of • •'plicant RECEIVED BY: Roil n Clerk's Office DATE: AUG 08 wwi , . 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