HomeMy WebLinkAboutDemaria •
Town Hall, 53095 Main Road
P.O. Box 1179
i�� Southold, New York 11971
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JUDITH T. TERRY ������ .....// 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. 1083-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner DEMARIA, JOHN H.
Mailing Address 1 595 OAKWOOD COURT
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 595 OAKWOOD COURT
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-211.71
Tax Map No. section 90.00 block 4 lot 7.000
Cross Street CEDAR BEACH DRIVE
Date Of Last Pump Out 0/00/00
Issue .Date: 4/14/89Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK c.OF°
Town of Southold Q ��G Application No. /6F 3
Judith T. Terry, Town Clerk ;;Y y
Town Hall, 53095 Main Road , ,,,, "= v �, =4
Residential
P. O. Box 1179 v' ;- '^ h�i z Non-Residential
V.Southold, New York 11971 O ® • S
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE 8�
OWNER NAME: v G 1 ,J 37 Je 1\714"12I ()-
OWNER MAILING ADDRESS: 575 Q,1--/ Wao-v !O4-p--r
„Coq-7-14-6'L Aly l/'� 7/
OWNER PROPERTY ADDRESS: E_
OWNER TELEPHONE NUMBER: -6'/6 74.6 4/7/
TAX MAP NO. : Section ! 0 Block Lot
CROSS STREET: Cyi. _
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ✓ New Existing v/
Residential V Non-Residential
DATE OF PREVIOUS PUMP-OUT: 71G71
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: a/ own Clerk's Office
DATE: ( / . 0// -
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