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JUDITH T. TERRY ; Town Hall, 53095 Main Road
TOWN CLERK ® P.O. Box 1179
REGISTRAR OF VITAL STATISTICS U, 3' Southold, New York 11971
MARRIAGE OFFICER
� Fax (516) 765-1823
® � �
RI et �1� .° Telephone (516) 765-1801
11
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3039-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner DAMANIS, DAMANIS, POULOS
Mailing Address 1 215-04 23RD ROAD
Mailing Address 2
City St Zip BAYSIDE NY 11360-0000
Property Address 1 745 STANLEY ROAD
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 718-631-3791
Tax Map No. section 106.00 block 8 lot 13.000
Cross Street BREAKWATER ROAD
Date Of Last Pump Out 0/00/00
s
Issue Date: 6/08/9.3 Judith T. Ter
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK ����FD
Town of Southold &_%-_ •- CQ Application No. �`�
Judith T. Terry, Town Clerk 'y; k ie',
Town Hall, 53095 Main Road `" , ` < t $10.00 - Residential 4�
P. O. Box 1179 cr3 ` - !,5. -'4 i $25.00 - Non-Residential
Southold, New York 11971 O� �
Telephone 1i
•
(516) 765-1801 1 � ,
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ j 7. O®
DATE .5-'3/"/3
OWNER NAME: 0/5143g/th<5 A94/2/941. ,e)7:-'e--4C.nc,S
OWNER MAILING ADDRESS: 2/S--(2 C7 V - ed;3"9_/-D
;w. y,5/7 - )X1 //� 0
- OWNER PROPERTY ADDRESS: 7916' S,/ -AiZicx A '
, ?��7/%ic.-�< J �� '/ .-
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OWNER TELEPHONE NUMBER: 7/ f�//t3/ 37,'1
TAX MAP NO. : Section >> Block r Lot-1-3
CROSS STREET: ��� �thV , "``' / 6���4704D
TYPE OF--SYSTEM: Septic Tank --""- New Existing
Cesspool New Existing -4....----
Residential t./.----- Non-Residential
DATE OF PREVIOUS PUMP-OUT: ,61/2"--22Z)�/0 ,
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.)
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Signature o Applica t
'RECEIVEIY BY-:- • ' s __ _ -
Town Clerk's Office
DATE: _" _ _ - -
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JUDITH T. TERRY yi - Town Hall, 53095 Main Road
TOWN CLERK " P.O. Box 1 179
REGISTRAR OF VITAL STATISTICS - - -' tq Southold. New York 11971
MARRIAGE OFFICER ' • ;`- Fax (516) 765-1823
j Telephone (516) 765-1801
J
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
•
• June 11, 1992
Mary Damanis
745 Stanley Road
Mattituck, New York 11952
Re: 106-8-13 5-92
Dear Ms. Damanis:
Our records indicate that you recently had your tank system
pumped -out. According to the Southold Town Scavenger Wastes Ordinance,
any owner-: of an: operating, -on-site sewage 'disposal- system, such as 'a 'septic
-- tank or scesspool,:must obtain, an Operation''Permit fo'r that system.
The Operation Permit is issued by the Southold Town Clerk's Office. The
fee is ten dollars ($10.00) for a' residential system, twenty-five dollars ($25.00)
for a non-residential system. You will not be asked to obtain an Operation
Permit each time you have work done on the system. The permit is only issued
once for each system.
Enclosed is an application for an Operation Permit. Please complete the
application and return it to this office along with the location map and proper
• fee. (NOTE: The location map may be a copy of your survey with the location ,
of the cesspool(s) indicated or a sketch of your property showing the location
of the buildings, cesspool system, and approximate distance in feet to buildings
and closest road.) Also included is an -Informational Bulletin regarding the ,
Southold Town- Scavenger Waste Treatment Facility. ,l hope this will aid you
in understanding the Scavenger Wastes Ordinance.,
Please -do 'not -ignore--this- request. Should.-you' have any 'questions or need.
any assistance -'with the,'application,-- please:'do-not=hesitate to contact this office. -
We` will be happy to' assist you in any way we possibly can.
Very truly yours,
•
• = •
Judith T. Terry -
Southold Town Clerk ,
Enclosures (2) - -
ljc •