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JUDITH T.TERRY „'y/ii!��� TELEPHONE
TOWN CLERK (516)765-1801
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. 725-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New X Existing
Name Of Owner DELARDOS, KONSTANTINOS
Mailing Address 1 7718 SIXTH AVENUE
Mailing Address 2
City St Zip BROOKLYN NY 11209-0000
Property Address 1 SUNSET DRIVE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 000-748-0710
Tax Map No. section 106. 00 block 8 lot 39.000
Cross Street DAISY ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 6/03/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK PFFD •,`
Town of Southold �O�,:• Application No. 7'25
Judith T. Terry, Town Clerk .
.c Residential
Town Hall, 53095 Main Road � ��" � �_, -
P. O. Box 1179 crs •x: lr ' �` Non-Residential
Southold, New York 11971 O d �� �$
Telephone •
-4eilaNT''
(516) 765-1801
RCmlrr ► TOWN OF SOUTHOLD
JUil 031988 SOUTHOLD WASTEWATER DISPOSAL DISTRICT
Town Clerk Southold
APPLICATION
- for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ 10..cP
DATE ST- 16 _ q
OWNER NAME: ILO sej\t
OWNER MAILING ADDRESS: G flue
o t•J , i VLOS
OWNER PROPERTY ADDRESS: -i St.
OWNER TELEPHONE NUMBER: i3'4e--03'10
TAX MAP NO. : Section OG Block ° Lot 3,
CROSS STREET: 0,A
TYPE OF SYSTEM: Septic Tank X New AX. Existing
Cesspool .""A New )( Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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 Applicant
RECEIVED BY:
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Town(Cle k' Office
REM'
DATE:
I �y0318B
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Ion Clerk Southold