HomeMy WebLinkAboutDivello OFFICE OF THE TOWN CLERK
Town of Southold
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road �� y � '�-.�
P. O. Box 1179 LI" =L�; "a g
Southold, New York 11971 Q` ; �0, •`
Telephone 0.(
(516) 765-1801 Px-
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 163 Residential X
- Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: John and Catherine DiVello
OWNER MAILING ADDRESS: RD 1 , 1155 Marys Road
Mattituck, New York 11952
OWNER PROPERTY ADDRESS: Westphalia Road
Mattituck, New York
OWNER TELEPHONE NUMBER: 516-298-5881
TAX MAP NO. : Section 113 Block g Lot 15.1
CROSS STREET: Route 48 •
TYPE OF SYSTEM: Septic Tank X New X Existing
• Cesspool X New X Existing
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: NA
•
Judith T. Terry
Southold Town Clerk
DATE: December 4, 1986
(TOWN"SEAL)
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OFFICE OF THE TOWN CLERK
c.5\\�FN
Town of Southold 0�� CQG Application No.
Judith T. Terry, Town Clerk
O. ; :„ y
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Town Hall, 53095 Main RoadResidential
. -
P. O. Box 1179 cn �.} ' : Non-Residential
Southold, New -York 11971 O •�`
Telephone 4/1 41 $7°:
(516) 765-1801 - �
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
/6 3
Operation Permit No. -
Fee $ WFn)
DATE //l26/Q',(7
OWNER NAME: Jo A V.-( .a71"A*, 0ihe Di t)cI/o
OWNER MAILING ADDRESS: R l / (Ss fv)qd2 s iQ
l�a1"1"i�uCk - P��• Y1l�5
OWNER PROPERTY ADDRESS: Wei 4•• /®cam
Aoff$ ; >LuCk i y 119s-a
OWNER TELEPHONE NUMBER: 029 3-5-8'8 ]
TAX MAP NO. : Section (j 3 Block 9 Lot 1 5: 1
CROSS STREET: koGil-e 4-$
TYPE OF SYSTEM: Septic Tank 1 .25 New Existing
Cesspool Y-es New LV- Existing
Residential \i e.5 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.)
(du_ , £ # �
ed-Li �
7kd/
Signature of Applicant
RECEIVED BY: vyt_d-c.---
Town CI k's Of ice
RECEIVE 04
DATE:
DLQ 03V4.
yowl CrYeh Southold
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