HomeMy WebLinkAboutTabor (2) OFFICE OF THE TOWN CLERK cO ,SLY'
Town of Southold ��.:' C
Judith T. Terry, Town Clerk � .'
Town Hall, 53095 Main Road .
P. O. Box 1179
York
Southold, New � ork 11971 ��0�
- .�
,ate .
Telephone 1
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation. Permit No. 566 Residential x
Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: Wendell Tabor
OWNER MAILING ADDRESS: Village Lane
Orient, New York 11957
OWNER PROPERTY ADDRESS: Village Lane
. Orient, New York
OWNER TELEPHONE NUMBER: 516-323-3624
TAX MAP NO. : Section 18 Block 5 Lot 8
CROSS STREET: Main Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool x New Existing x
Residential x Non-Residential
DATE OF PREVIOUS PUMP-OUT: 1985 -
Judith T. Terry
Southold Town Clerk
DATE: January 8, 1988
(TOWN SEAL)
OFFICE OF THE TOWN CLERK .SFOUr� /
Town of Southold 0��� - ,;�QG' Application
Judith T. Terry, Town Clerk
wr
Town Hall, 53095 Main Road .G ! - Residential
P. -0. Box 1179 L' _`A' `� Non-Residential
Southold, New York 11971 O ® �4 �0 •�`�
Telephone . • '
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
•
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permi Noc' , C
Fee $ l U
DATE /./) ,/ Fr
OWNER NAME: 2 y� e LL ( a tj p y
OWNER MAILING ADDRESS: t ' LLoL. L- c� v►. 2
Ll'Y I
OWNER PROPERTY ADDRESS : SoL, Wv,e—
OWNER TELEPHONE NUMBER: - 3 Co a-
TAX MAP NO. : Section 1 D Block 3 Lot F
CROSS STREET: PkiN .0 .
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool !V New Existing .4--
Residential ?j' Non-Residential
DATE OF PREVIOUS PUMP-OUT: ,19 io
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.)
a/ve-- lii 't i
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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