HomeMy WebLinkAboutCommander VVI •
111 Vitir
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Town Hall, 53095 Main Road
1 P.O. Box 1179
Southold, New York 11971
JUDITH T.TERRY
FAX(516)765-1823
TELEPHONE(516)765-1801
TOWN CLERK
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. 966-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner COMMANDER, DAVID
Mailing Address 1 P. O. BOX 211
Mailing Address 2
City St Zip LAUREL NY 11948-0000
Property Address 1 795 LAURELWOOD DRIVE
Property Address 2
City St Zip LAUREL NY 11948-0000
Owner Telephone No. 516-298-5092
Tax Map No. section 127.00 block 7 lot 3.000
Cross Street PECONIC BAY BLVD
Date Of Last Pump Out 5/00/88
Issue Date: 12/20/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK �COFO( ,r. --
Town of Southold �� <IV% Application_ No. 76, '
Judith T. Terry, Town Clerk y
Town Hall, 53095 Main Road ; :<4 Residential
P. (13 `.4
O. Box 1179 � �r �, �i�;' Non-Residential
Southold, New York 11971 0 0, . " 0-
Telephone : 1 * `A 6°
(516) 765-1801
TOWN 06•-SOUTHOLD
SOUTHOLD A� STEWATER DISPOSAL DISTRICT
DEC 0 5 MG
lawn lal APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /o
DATE J2'''
OWNER NAME: Orb} `V 60'� 1/1A04V
OWNER MAILING ADDRESS: o L 1/
-a1uv // (7/S Laos-/ oacia,
OWNER PROPERTY ADDRESS: -
OWNER TELEPHONE NUMBER: ( - /27— / 3
1- Jctroc9J!
TAX MAP NO. : Section 6cra-ea Block Lot 7
CROSS STREET: IPQ- c. 4tat, /S /ui
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New t Existing
Residential L/ Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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.)
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Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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