HomeMy WebLinkAboutDepetris ® Town Hall, 53095 Main Road
JUDITH T. TERRY
TOWN CLERK P.O.® trill r� Box 1179
REGISTRAR OF VITAL STATISTICS o �� Southold, New York 11971
MARRIAGE OFFICER 1�� , Fax (516) 765-1823
4iiI) s2 ��®��► Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1932-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner DEPETRIS, WILLIAM AND ANNE
Mailing Address 1 RR1, BOX 4, 100 OLD PASTURE RD
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 100 OLD PASTURE ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-6019
Tax Map No. section 103.00 block 11 lot 18.000
Cross Street PEQUASH AVENUE
Date Of Last Pump Out 0/00/80
Issue Date: 6/24/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
I
•
OFFICE OF THE TOWN CLERK COFOUr''-
Town of Southold Q ,. . CQG Application No. /93
Judith T. Terry, Town Clerk ' 2
flfr
Town Hall, 53095 Main Road c ;:� :'� $10.00 - Residential
P. O. Box 1179 .fl �• $25.00 - Non-Residential
Southold, New York 11971 O0�,.•�`
Telephone *0'44-7Y► '
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation`Permit No.
Fee $ /C) a
DATE — 16 - 91
OWNER NAME: Lo/L ,t1 L. i4VP Avair 7 j 772E 5
OWNER MAILING ADDRESS: R-R- I 6.c f{ /t2d ®LO AiN ' R9
C) UTC (',�r! , UL 0?c3r
OWNER PROPERTY ADDRESS: Some-
OWNER TELEPHONE NUMBER: 51,6 — 73 '( — ‘619" 1,49 -/ /-
R g
S = — V73 rx
TAX MAP NO. : Section d+te 5u�f�-Block Lot C C.S' 2/U
CROSS STREET: �-(=GIQA-s d 4 )6 *ft, (9W) 064-STvW 1W _
TYPE OF -SYSTEM: Septic Tank - New Existing
Cesspool )' New Existing X
Residential ( Non-Residential
DATE OF PREVIOUS PUMP-OUT: 1170
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: -
Town Clerk's Office
DATE:
. . -
, .
. .
. .
. ,
. ,
Piti—'471/11 &--- kp,
•
_ .
, .
. .
. ,. .
, .
. ,
, it 7.,, i•
..
, •
. .
•,.".4 (
. ,
1i ir '
OP', .
zo
. .
....
. . .
.1.1-....arzr cluvrva...r..,...m............................m,N,,,,,N.,•,,..nms..-,-2 '''' ...... , .,_ _ N.. ' . .
, .
. ,
-.-----(- ----71-11...-1"
. Z,5,14,101,
....z,r
T 0''''
ee.
. .
i., .
•1
; .
•
•
. .
, .
....1
kiE
r-- .
.•
. .
• .
, .
. ,
.• .. _..... •
. ,
• v
. ,
. . .
. .
• .
. . .
. _
, .
•
,•„
. . ,
•,
. .
. .
. v
. . .
. ,
. ,
. ,
. .
,.. .. .. ., . _ v ... ...____._...... .._ . . ,
..... . . v .
, ..
. .
. .
•_ t.;
.. .
.
. .
. , . .
.
.