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Home My WebLink AboutDeConciliis OFF001, -- G` JUDITH T.TERRY �� tLN Town Hall, 53095 Main Road TOWN CLERK t 4=1 Z t P.O. Box 1179 w• °�9 �� Southold,New York 11971 REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER `�'4 ®� 1�' Fax (516) 765-1823 � RECORDS MANAGEMENT OFFICER ®1„ _ `0'0d Telephone (516) 765-1800 FREEDOM OF INFORMATION OFFICER ...- OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 3493-R Residential X Non-Residential Fee $ 10.00 New Existing X Name Of Owner DE CONCILIIS, NANCY Mailing Address 1 415 GRANGE ROAD Mailing Address 2 City St Zip SOUTHOLD NY 11971-0000 Property Address 1 415 GRANGE ROAD Property Address 2 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 516-765-511.32 Tax Map No. section 78.00 block 1 lot 7.000 Cross Street MAIN BAYVIEW ROAD Issue Date: 8/15/96 Judith T. Terry Southold Town Clerk (TOWN SEAL) • • UFFICE OF THE TOWN CLERK caFe(ir Ar"- Town of Southold �� I, T.. Application No. '-t13 Judith T. Terry, Town Clerk .� 'XM. . y _ Town Hall, 53095 Main Road , �� $10.00 Residential P. O. Box 1179 '� ;;« 'c iii Z' $25.00 - Non-Residential Southold, New York 11971 Telephone 1 y► (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ / DATE 7/36r/.? r/ r r/// OWNER NAME: ot,✓%c'---ir OWNER MAILING ADDRESS: �� R . • At 77 OWNER PROPERTY ADDRESS: OWNER TELEPHONE NUMBER: 7 'S' --, < er3 2 _ TAX MAP NO. : Section /7 ? Block / Lit _4 CROSS STREET: hio( TYPE OF SYSTEM: Septic Tank New Existing 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.) O� n Signature of Applicant RECEIVED BY: Town C erk's Office DATE: , i'V , s. A G- R A 14 C- 5 RI) t — — r ° FORGE F. McADAM S • 415 Grange Road O Southold, EL Y1 11971 J ox�I z IF 100 > e I`. it r H04JSE I i I S i NI Q O ! i ' I i L . gVFFO(,C 1 �� COGy JUDITH T.TERRY Town Hall, 53095 Main Road TOWN CLERK y P.O. Box 1179 �• ,�� Southold,New York 11971 REGISTRAR OF VITAL STATISTICS • O MARRIAGE OFFICER � ®�iii' Fax(516) 765-1823 RECORDS MANAGEMENT OFFICER �l �1�i Telephone(516) 765-1800 FREEDOM OF INFORMATION OFFICER �,,,,••�� OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD July 22, 1996 Nancy Deconciliis 305 Grange Road Southold, New York 11971 Re: 78-1-7 6/3/96 Dear Ms. Deconciliis: Our records indicate that you recently had your cesspool/septic 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 cesspool, must obtain an Operation Permit for 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 aldng 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. I 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) Ijc / oil Or FFOti _ JUDITH T.TERRY °� 'g,.v . #� Town Hall, 53095 Main Road TOWN CLERKti , w = 2 P.O. Box 1179 REGISTRAR OF VITAL STATISTICS } •• wl ►� Southold,New York 11971 MARRIAGE OFFICER � -.. 1111 Fax(516) 765-1823 RECORDS MANAGEMENT OFFICER —_ Olglig 'rase Telephone (516) 765-1800 FREEDOM OF INFORMATION OFFICER ,/, ,/i OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD July 22, 1996 Nancy Deconciliis 305 Grange Road Southold, New York 11971 Re: 78-1-7 6/3/96 Dear Ms. Deconciliis: Our records indicate that you recently had your cesspool/septic 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 cesspool, must obtain an Operation Permit for 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 doneon 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. I 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, s r Judith T. Terry Southold Town Clerk Enclosures (2) Ijc