HomeMy WebLinkAboutDiNicola, Frank ,o,,o�oSqFFot,�'0G
ELIZABETH A. NEVILLE ��,_� y� Town Hall, 53095 Main Road
TOWN CLERK y - P.O. Box 1179
Southold,
REGISTRAR OF VITAL STATISTICS k �'
New York 11971
MARRIAGE OFFICER :�1i , ,l Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER ; �IQ1 . rrrr,.' Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4202-R Residential x Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner DENICOLA, FRANK & PATRICIA
Mailing Address 1 635 CHABLIS PATH
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 635 CHABLIS PATH
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
owner Telephone No. 631-765-6375
Tax Map No. section 51.00 block 3 lot 30.040
Cross Street SOUNDVIEW AVENUE
Clia441C?
Issue Date: 5/15/03 Elizabeth A. Neville
Southold Town clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK COMA' _ 1.12a
TOWN OF SOUTHOLD , �, � ; Application No.
ELIZABETH A.NEVILLE,TOWN CLERK $10.00 - Residential
P.O.BOX 1179
cr)SOUTHOLD,NEWYORK11971 $25.00 - Non-Residential
Telephone A( `�� '
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE b h0 Ia)
OWNER NAME: 4104-1J b� A" I k, C I, fit C.. tb iA
OWNER MAILING ADDRESS: 6i sr C//n f L, 5 1911- t 17
so 47/o LI) N. y. //9 /
OWNER PROPERTY ADDRESS: c4- 41
OWNER TELEPHONE NUMBER: C3/- 71f 3 7 c
TAX MAP NO. : Section Si•a0 Block 3 Lot 3. ber
CROSS STREET: ,Sp c,N/,/) Li/CIL) ?- c'
TYPE OF SYSTEM: Septic Tank New 'ixisting
Cesspool � New 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.)
'1
. ea(; ,}
14
Signature of Ap cant
RECEIVED BY: ii211-)61-)V`-'1
1f [[ Town Clerk's Office
DATE: / I VAU )