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Town Hall, 53095 Main Road
C) 1+ w� P.O. Box 1179
�� 0,•;" Southold, New York 11971
JUDITH T.TERRY
FAX(516)765-1823
TOWN CLERK 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. 1028-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner B I GGS, ROBERT
Mailing Address 1 524 STERLING PLACE
Mailing Address 2
City St Zip GREENPORT NY 11944-0000
Property Address 1 524 STERLING PLACE
Property Address 2
City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 516-477-0692
Tax Map No. section 34.00 block 3 lot 8.000
Cross Street KNAPP PLACE
Date Of Last Pump Out 4/17/84
Issue Date: 2/22/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK cOFDCA- '-
Town of Southold �� CQ •- Application No. j
Judith T. Terry, Town Clerk �� :. ,�{ ; ►
Town Hall, 53095 Main Road �. -'� Residential
P. 0. Box 1179ms' s= 'z Non-Residential
Southold, New York 11971 O
Telephone 410../jr,-
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
. .q for
FEB 16 Me OPERATION PERMIT
n'� °' S" ? SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE (2t A/ff
OWNER NAME: d ,S} /er k/((oGL.0
OWNER MAILING ADDRESS: Sty $//2pL!144' //
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: �! 77 ,o 6 9 Z
TAX MAP NO. : Section gq Block 3 Lot
CROSS STREET: /C�7 p 2)
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: ,'ql/i/ �f q
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.)
9/: XeepW
Si.nature of Applicant /
RECEIVED BY: o-c,-)c-tole L d
g ,wn Cie'k's Offi e
DATE: FEB 22 1989
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