HomeMy WebLinkAboutAgria, John oiii OFFOLt
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ELIZABETH A. NEVILLE 1''��=�0 y� Town Hall, 53095 Main Road
TOWN CLERK o P.O. Box 1179
W �t Southold, New York 11971
REGISTRAR OF VITAL STATISTICS 47? Fax(631) 765-6145
MARRIAGE OFFICER :�
RECORDS MANAGEMENT OFFICER � '7Q *a��1� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER .1
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4022-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner AGRIA, JOHN J.
Mailing Address 1 P. O. BOX 133
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 42340 MAIN ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 631-765-5667
Tax Map No. section 630.00 block 6 lot 9.000
Cross Street OAKLAWN AVENUE
Issue Date: 4/25/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK COFO(,,(r
TOWN OF SOUTHOLD 0� CSG Application No. z Z
ELIZABETH A.NEVILLE,TOWN CLERK4-4
$10.00 - Residential
P.O.BOX 1179
SOUTHOLD,NEWYORK11971 *'$ $25.00 - Non-F�esidential
Telephone _�j * N
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. o20-Cb 4
Fee $ `6 ,l
DATE 6 Zi ov
OWNER NAME: Z.011 InI" L a
OWNER MAILING ADDRESS: ?Z) Q (2s 2, 3 3
Sou x461, WY \
OWNER PROPERTY ADDRESS: 52-3 JV VVlEly )2d. -
sovlho l.d Alt( I Lq. 7 I
OWNER TELEPHONE NUMBER: 6'31 ` 6,37 _5-667
TAX MAP NO. : Section 63 Da Block .6 Lot
CROSS STREET: Oak\- �W Yv
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ✓ New Existing ✓
Residential Non-Residential
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.)
eA°.:
ature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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