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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK ac P.O. Box 1179
REGISTRAR OF VITAL STATISTICS � �
Southold, New York 11971
MARRIAGE OFFICER NrFax
Telephone(516)(5 765-1823 768
1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1807-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner TABOR, E. KENNETH
Mailing Address 1 P. O. BOX 115
Mailing Address 2
City St Zip ORIENT NY 11957-0000
Property Address 1 ORCHARD STREET
Property Address 2
City St Zip ORIENT NY 11957-0000
Owner Telephone No. 516-323-2489
Tax Map No. section 25.00 block 2 lot 21 .000
Cross Street TABOR ROAD
Date Of Last Pump Out 0/00/00
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Issue Date: 11/19/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFi-CEOF •THE TOWN CLERK •c3VFFO(,r =
Town of Southold O&Q #fi.: CQG', Application No. /YO 7
Judith T. Terry, Town Clerk ' '`' ? `) $10.00 - Residential 47,7,0
Town Hall, 53095 Main Road 8
P. O. Box 1179 cr3 , X z $25.00 - Non-Residential
Southold, New York 11971 P2'tas
Telephone �j * �� oe
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ '`/Q
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DATE // // I-/ /
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OWNER NAME: E. /1/ 7/////15-77)1 /2,& e.
OWNER MAILING ADDRESS: '6 • dCX
ORLeitYr ALS,
OWNER PROPERTY ADDRESS: (0 Ip C E-{-f}-` b p.
P t rr`,09— Al // 95-'7
OWNER TELEPHONE NUMBER: �j' i (pa 3 -- c (iW9
TAX MAP NO. : Section Block Lot c9N
CROSS -STREET: T -R E. e h.
TYPE OF SYSTEM: Septic Tank / New - Existing I
Cesspool New Existing
Residential V Non-Residential
DATE OF PREVIOUS PUMP-OUT: lk) W It t,C;G'k1
LOCATION MAP: Must be attached hereto before permit maybe issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
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_ RECEIVED BY: -
Town lerk's Office
RECEIVED -
DATE: - -
N O V 13 191
Town Clerk Soutf101d
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