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HomeMy WebLinkAboutDiBartolo i,,,, o%!,', it ELIZABETH A. NEVILLE 0 ; Town Hall, 53095 Main Road TOWN CLERK % ® P.O. Box 1179 Southold, New York 11971 REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER ` ®� ��11, Fax (631) 765-6145 RECORDS MANAGEMENT OFFICER � �®� ss22 111 Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER ,�'� moo OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 4019-R Residential X Non-Residential Fee $ 10.00 New Existing X Name Of Owner DIBARTOLO, NICOLO & CAROLINE Mailing Address 1 475 CONDOR CT Mailing Address 2 City St Zip LAUREL NY 11948-0000 Property Address 1 475 CONDOR CT Property Address 2 City St Zip LAUREL NY 11948-0000 Owner Telephone No. 631-298-5423 Tax Map No. section 127.00 block 3 lot 6.002 Cross Street WHITE EAGLE DRIVE Issue Date: 4/11/00 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) l !J .00 OFFICE OF THE TOWN CLERKc,VFFOL" TOWN OF SOUTHOLD % '4"1\ Application No.7) T ELIZABETH A.NEVILLE,TOWN CLERK '4'' , ; $10.00 - Residential P,O.BOX 1179 ` SOUTHOLD,NEW YORK 11971 ;. ,u � 05.00 - Nonoll®ttI d®w+ticl�__,�,,, Telephone (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ • DATE /1I9 I( 3 - c O OWNER NAME: lG6/� (.) 40t/ /I�� iB 7 1 (7 OWNER MAILING ADDRESS: $75 6®00r et //9W OWNER PROPERTY ADDRESS: /7 7� C0lt4©,- T -- -iL 4/ / /9 t OWNER TELEPHONE NUMBER: TAX MAP NO. : Section /02710o Block ,3 Lot CROSS STREET: 776. TYPE OF SYSTEM: Septic Tank New Existing Cesspool New c Existing Residential Non-Residential 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.) Signature of A•plicant RECEIVED BY: Town Clerk's Office DATE: i 6)0,2 °:; — e - o ' z-z? ' 0, )4ii, i_gs ' e -°(1---' ))17 IMs'5,1 ---zi3Ogi --)72(afr y/& - 9 _ 4 „ ,g9':- 49,3 -V N"i:AVii),4. ' ----=';:r4/31A1 l' ---3_, ioq%,)0 i , ,.,, 1 }d 00S - t. ,0)9 o ql _Moo/ MO): \Idlt1;) i jr o Om -;/ ,-1-171/11--- i M4v� �� )577hg- / 2 7o/4, _ j_, - Q) V &y.) S • ) 74. 1