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HomeMy WebLinkAboutDeluca _ illow Fair -- • JUDITH T.TERRY Town Hall,53095 Main Road TOWN CLERK P.O.Box 1179 REGISTRAR OF VITAL STATISTICS o ',� Southold,New York 11971 Fax(516)765-1823 MARRIAGE OFFICER ` ��+ ��� RECORDS MANAGEMENT OFFICER ®d ED `,��� 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. 3295-R Residential X Non-Residential Fee $ 10.00 New X Existing Name Of Owner DELUCA, N. CHARLES AND SYLVIA Mailing Address 1 2401 HALYARD DRIVE Mailing Address 2 City St Zip MERRICK NY 11566-0000 Property Address 1 3525 ROBINSON ROAD Property Address 2 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 516-223-0567 Tax Map No. section 81 .00 block 1 lot 15.006 Cross Street NORTH BAYVIEW ROAD Issue Date: 12/14/94 Judith T. Terry Southold Town Clerk (TOWN SEAL) r , „ OFFICE OF THE TOWN CLERK .�OFRA.-' Town of Southold ® � QG , Application ,No. 302_75— Judith T. Terry, Town Clerk ;, y Lam' Town Hall, 53095 Main Road CKs } $10.00 7 Residential P. O. Box 1179 u$2 x 'L �� ► �• $25.00 - 'Non-Residential Southold, New York 11971 � •�` -To �o •• Telephone = .( N (516) 765-1801 TOWN OF SOUTHOLD ` ,ns SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ DATE \�c?,L, / /9P5/ OWNER NAME: .0c-Ae s y �� ` � v C �- OWNER MAILING ADDRESS: 2.401 \-\ 01\ c c\ ; „ e, OWNER PROPERTY ADDRESS: 3 51.-S 3),.O"O \A S© \a,_ OWNER TELEPHONE NUMBER: 51 123 - 05t7 TAX MAP NO. : Section 0 gyp° Block Lot CROSS STREET: 42j,j. �x�t�eC� - TYPE OF SYSTEM: Septic Tank New Existing Cesspool New Existing Residential e/ Non-Residential DATE OF PREVIOUS PUMP-OUT: d • LOCATION MAP: Must be attached hereto before permit may be issued. _ (Locate building and system; give north arrow and feet of distance, c.pprcx!matel✓, to building- and closest road.) - — Signature of Applicant RECEIVED BY: AL/ /1L.--t4f; • Town Clerk's Office DATE: r\; \-\o • N\ 6711111111'141110111111. .31 ILO - , D n