HomeMy WebLinkAboutDolomite ofFour
toxo Geo+:
ELIZABETH A.NEVILLE ® ;c Town Hall, 53095 Main Road
TOWN CLERK y 2 % P.O. Box 1179
rri
0 Southold,New York 11971
REGISTRAR OF VITAL STATISTICS `` y ®�'�� Fax(516) 765-1823
MARRIAGE OFFICER _ ( . ,• Telephone(516) 765-1800
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER ""',,
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3811-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner DOLOMITE, VINCENSO
Mailing Address 1 56861 MAIN ROAD
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 56861 MAIN ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-2436
Tax Map No. section 63.00 block 3 lot 17.004
Cross Street HARBOR ROAD
Issue Date: 9/11/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
' OFFIE OF THE TOWN CLERK ••
(JO FOU( _
TOWN OF SOUTHOLD , N) �4 Application No.8 8'1/
, ELIZABETH A.NEVII.i.F,TOWN CLERK _ ` q $10.00 - Residential
P.O.BOX 1179
SOUTHOLD,NEW YORK 11971 � $25.00 - Non-Residential
® "1
, Telephone -- 49j
(516) 765-1801 - '�
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE 714.7 2iv W
0 --
OWNER NAME: //e A,.e�%!Z.c). a 4 74--/-e.._-te-,
OWNER MAILING ADDRESS: 7C/1)-6/ G/76(1X,/v, /2
OWNER PROPERTY ADDRESS:
•
OWNER TELEPHONE NUMBER: /5 ' EA e476
y TAX MAP NO. : Section 6 5 Block Lot G 74„
CROSS STREET: - fa. x iec
TYPE OF SYSTEM: Septic Tank c'4 New - Existing '4
Cesspool N New Existing V
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.)
1.,n-Q,DIA/
Signa ure of Applicant
RECEIVED BY:
Town Clerk's ice
DATE: 9/A/7g*
a
A)
\') -14)1 4 F
at 4 ,.
z.
la S �o s
T ^i; N.) 74-7/
- 7y 778
411441/4.
�o -,--,c e L_-, N.,-, ,-• i L DSA-c
c'
(;-:rn •• 1
s iJ• 2 3 " o m o o /O a o s/t
S.r s.t
i t • -s
0 -
0 0
i
: CESS�c� \ r
h
J G
I 7
' n •, J _
`<
— �Il — 3G f
? ; H v _3 4 !
IFeuer ‘.C. 0; ! \\kJ
Y
J 0 oc,
d � 1 `-1--o. s 3y J
1 — q a J
J �-4i l' .\ 0 111 I
i
r !
`1 01 9 , 0 0
I- n
'V
$ - \o! Lo i
b C
k.) /
r��L�
se/- cnr
! /S.-.-T 23' oo• o o• Lz – `�/ – — �So.oa
/ 00 00 i __
rh
C- 6 X //Fc /r /y�0.47 D