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OFFICE OF THE TOWN CLERK 6 cOFOUr
Town of Southold �G
Judith T. Terry, Town Clerk 3I-4-
Town
-Town Hall, 53095 Main Road ,
P. 0. Box 1179 1.11 1.51;. 'V
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Southold, New York 11971 riAir
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Telephone 01 44 1�.
(516) 765-1801 - I--
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation. Permit No. 549 - Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: Charles Babcock
OWNER MAILING ADDRESS: 1075 Victoria Drive
Southold, New York 11971
OWNER PROPERTY ADDRESS: 1075 Victoria Drive
Southold, New York
OWNER TELEPHONE NUMBER: 516-765-2499
TAX MAP NO. : Section 78 Block 9 Lot 5,
CROSS STREET: Liberty Lane
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
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Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: 10-26-87 -
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Southold Town Clerk
DATE: December 24, 1987
(TOWN SEAL) ,
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OFFICE OF THE TOWN CLERK Ic3IFOUr��=
Town of Southold Oho w •Y. CS ' Application No. 6-W
Judith T. Terry, Town Clerk „ �,y:
Town Hall, 53095 Main Road ¢, ' "� Residential
P. O. Box 1179 cry ” .Ek ;' Non-Residential
Southold, New York 11971 O
Telephone ol •
(516) . 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
RECEIVED
DEC 211987 OPERATION PERMIT
Prawn Clerk Southold SEPTIC TANK or CESSPOOL
Operation Permit No. .5 'Y
• Fee $ /d
DATE 1.A. — ( .7 ` `°
OWNER NAME: C,LI R pL.:S OC1 E. coC' K
OWNER MAILING ADDRESS: /07,' Vic%d tD JR D ,I VE
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OWNER PROPERTY ADDRESS: ) 07%r Vi C 102 I / 0 CIE f
c� u r t^1 Cal lD l'1/°'k Y
OWNER TELEPHONE NUMBER: jf ,/ 9 ci
TAX MAP NO. : Section 7g Block 9 Lot . ,-
CROSS STREET: e Try
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TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing 'J/LS
Residential y '„s Non-Residential
DATE OF PREVIOUS PUMP-OUT: 9c?' /)O (s ( S,3' pooL-
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: •"1 ��_
n/ Town Ir'rk's Of'ice
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cs� r' Town Hall, 53095 Main Road
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P.O. Box1179
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;moi Southold, New York 11971
JUDITH T. TERRY '`< L :o TELEPHONE
TOWN CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
December 21 , 1987 -
T
To: Charles Babcock -
From: Southold Town Clerk's Office
Re: Cesspool Operation Permit
Please indicate, on the attached survey, the location of the Cesspool System,
giving approximate distance, in feet, to building and nearest road.
Upon receipt of the additional information, your permit may be processed.
Thank you.
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