HomeMy WebLinkAboutDemetriou Town Hall, 53095 Main Road
P.O. Box 1179
loot•o- Southold, New York 11971
JUDITH T.TERRY '=4...r m 0'4' FAX(516)765-1823
TOWN CLERK TELEPHONE(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. 1290-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner DEMETRIOU, PETE AND HELEN
Mailing Address 1 PETROPOULLOU, CHRYSTALA
Mailing Address 2 605 RUTH ROAD
City St Zip MATTITUCK NY 11952-0000
Property Address 1 605 RUTH ROAD
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-5721
Tax Map No. section 106.00 block 7 lot 19.000
Cross Street BREAKWATER ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 10/31/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK '
Town of Southold O��F C� Application No. /a-5'O
Judith T. Terry, Town Clerk
Town Hall, 53095 plain Road %� $10.00 - Residential
L a r E`
P. O. Box 1179 �_'�#-.��, �,�,�,`��: ; $25.00 - Non-Residential
Southold, New York 11971 O �m,' �0 �`�
Telephone : n • of
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE
OWNER NAME: 7a _t_f_it, � � - C/1 i 2 S w t.,* f' ,�,f t.o ro lib 0
OWNER MAILING ADDRESS: Z,a 5 ) j
71)cc,
OWNER PROPERTY ADDRESS: 65- /a...v.& _
OWNER TELEPHONE NUMBER:
TAX MAP NO. : Section MC, Block Lot / Y
CROSS STREET: iejtect.ALe /--
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool 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.)
re-/&
Signature o Applicant
RECEIVED BY: rrj
' rown Clerk's Office
DATE: OCT 31
16140 CIO( %Nadi
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