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HomeMy WebLinkAboutDaskalopoulos (2) opief/0 °! A Town Hall, 53095 Main Road w "' 4�` P.O. Box 1179 •�• Southold, New York 11971 JUDITH T.TERRY ® 0 I.0.• 5 6L 1 TELEPHONE TOWN CLERK 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. 907-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner DASKALOPOULOS, GEORGE Mailing Address 1 SOUNDVIEW AVENUE Mailing Address 2 City St Zip SOUTHOLD NY 11971-0000 Property Address 1 SOUNDVIEW AVENUE Property Address 2 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 516-765-2078 Tax Map No. section 51 .00 block 4 lot 8.000 Cross Street CLARK ROAD Date Of Last Pump Out 0/00/00 Issue Date: 11/09/88 Judith T. Terry Southold Town Clerk (TOWN SEAL) x I OFFICE OF THE TOWN CLERK Town of SoutholdCQG' , Application No. 9 0 7 Judith T. Terry, Town Clerk tc »r y ° • - Residential Town Hall, 53095 Main Road P. O. Box 1179 cn 01 4 =-1-T7-v �` Non-Residential Southold, New York 11971 O ® � f� � � Telephone (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ • DATE /f.• 'S` •. OWNER NAME: FOR OWNER MAILING ADDRESS: 8©C//YJy/e14/ '4 VE - S'ou7I OWNER PROPERTY ADDRESS: ,g/J-fJY- OWNER TELEPHONE NUMBER: $-/ -- 76'Kr"2c77 TAX MAP NO. : Section 57 Block 4 Lot 69 CROSS STREET: w0-.erv‘ £- TYPE OF SYSTEM: Septic Tank New Existing Cesspool New Existing Residential v- Non-Residential DATE OF PREVIOUS PUMP-OUT: A 41. 17 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.) ignature of plicant RECEIVED BY: Town Clerk's Office DATE: K-A C. o E:17,0 c-.0 C E S S'P©o L L c7 C -r( o ri • � I S®v.Ni) ( �' -