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JUDITH T. TERRY 17:1 Town Hall, 53095 Main Road
TOWN CLERK __ P.O. Box 1179
REGISTRAR OF VITAL STATISTICS c- Southold, New York 11971
MARRIAGE OFFICER Fax (516) 765-1823
Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1646-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner BARKER, LOIS W.
Mailing Address 1 P. O. BOX 1458
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 LUPTON POINT ROAD
Property Address 2
City St Zip MATTITUCK NY 11952-0000
-Owner Telephone No. 516-298-8845
Tax Map No. section 115.00 block 3 lot 27.000
Cross Street MARRATOOKA ROAD
• Date Of Last Pump Out 0/00/00
Issue Date: 3/14/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
" .., •
OFFICE Of THE TOWN CLERK c,VFFoure-
Town of Southold � '� � Application No. / ,476
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road -! - . I $10.00 - Residential
P. O. Box 1179 cn °' z ii , ,;. $25.00 - Non-Residential
Southold, New York 11971 0 *-$
Telephone 0.( `1►
(516) 765-1801
TOWN OF SOUTHOLD
•
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
-4' APPLICATION-
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SEP t 1990 c for
Vett �9:`' `, OPERATION PERMIT
IconSEPTIC TANK or CESSPOOL
Operation Permit No.
®o'
Fee $ Jv: X
DATE 941- 47d
OWNER NAME: Z Of/ S ZAQN1 r' •
OWNER MAILING ADDRESS: 60,4®K ran* r'®`)01. Par'
h!'4i To c/L k.y. • 111140--
OWNER PROPERTY ADDRESS: -
•
OWNER TELEPHONE NUMBER: Aplt 880-
TAX MAP NO. : Section f '5 Block 1 L Lot
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool � New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT:
4
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.)
Signatur of‘Ag.
..licant
RECEIVED BY:
Town Clerk's Office
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L.65 / 49 42.1q r
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