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� Town Hall, 53095 Main Road
P.O. Box 1179
__� �®�, 4Southold, New York 11971
JUDITH T.TERRY ®I ED il��. FAX(516)765-1823
TOWN CLERK az,HO° TELEPHONE(516)765-1801
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. 1275-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner BEST, MARGARET M.
Mailing Address 1 P. O. BOX 609
Mailing Address 2
City St Zip MATTTIUCK NY 11952-0000
Property Address 1 CAMP MINEOLA EAST EXTENSION
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-4390
Tax Map No. section 123.00 block 6 lot 17.000
Cross Street CAMP MINEOLA ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 10/18/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
OFFICE OF THE TOWN CLERK c3t-FQt,i,�'-
Town'of Southold A . Application No. \'f'\`)
Judith T. Terry, Town Clerk % o 4 ` l/ `
� ��
Town Hall, 53095 Main Road � �: . $10.00 - Residential
P. O. Box 1179 u' �0 ';r'1 $25.00 _ Non-Residential
Southold, New York 11971 O %''
Telephone Q( `e"
•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
SEP 2 5 i989 OPERATION PERMIT
10 ,if cls; So_tp, SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE g /r
OWNER NAME: _ Inn
OWNER MAILING ADDRESS: 3O?C_ (.0 Da\
Q,Ldvl CY)ecnT a y
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: 57 (.p - 43(76
TAX MAP NO. : Section f O®d Block /0-3 O of 17
CROSS STREET: exurn I r ) , C\ T-CSI
TYPE OF SYSTEM: Septic Tank " V New Existing
Cesspool New Existing
Residential - Non-Residential
DATE OF PREVIOUS PUMP-OUT: J u l
J1 (9 b
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.)
Signatuu e of Applicant
gtlICEVID
OCT 18 'ft$
RECEIVED BY:
Tara-gloom ffice
DATE:
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